Abstract
Background: Tracheostomy is widely regarded as the method of choice for long-term airway control
in critically ill patients. The advantages of tracheostomy have to be balanced against
the surgical risks of conventional surgical tracheostomy. However, the alternative
technique of percutaneous dilatational tracheostomy (PDT) has been associated with
fewer procedure related complications. Methods: The results of PDT following cardiac surgery were investigated in a prospective study
(1/1995 - 9/1997). The procedure of Ciaglia (1985), a modified Seldinger technique,
was performed under endoscopic guidance in 88 patients, 30 women and 58 men, with
a mean age of 56.6 ± 14.5 years. Results: PDT was successfully performed in all cases after a mean of 14.6 ± 9.0 days of translaryngeal
intubation. No serious procedural complications occurred; a minor hemorrhage occurred
in 12 patients and a cuff defect in 2 patients. 49 patients (55.7%) were weaned from
mechanical ventilation, and 45 patients (51.1%) were decannulated after a mean tracheostomy
duration of 18.9 ± 27.2 days. 38 patients died of their underlying disease while still
being mechanically ventilated. A total of 20 postprocedural complications were observed
in 15 patients: stomal infection (7), minor hemorrhage (4), tracheal stenosis (3),
tube displacement (2), delayed wound healing (2), soft-tissue hemorrhage (1), and
organ hemorrhage (1). During long-term follow-up a good functional and cosmetic result
could be documented in the majority of 35 patients. Conclusions: PDT can be performed safely in patients following cardiac surgery as a bedside technique
with a low incidence of procedural and post-procedural complications and an acceptable
functional and cosmetic long-term outcome. Further studies are needed to define the
optimal timing of PDT after translaryngeal intubation.
Key words
Percutaneous tracheostomy - Results - Prospective trial
