CHICAGO- Percutaneous dilation tracheotomy (PDT) is becoming an accepted and increasingly popular alternative to surgical, or open, tracheotomy, particularly in the treatment of critically ill patients requiring prolonged intubation and mechanical ventilation. There are, however, important contraindications to consider and a learning curve that must be overcome in order to reduce the risk of complications, according to David Goldenberg, MD, Associate Professor of Head and Neck Surgery and Oncology at the Milton S. Hershey Medical Center of Penn State College of Medicine in Hershey, Pa.
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September 2006Dr. Goldenberg presented the results of a study looking at PDT complication rates to the Triological Society here at the 2006 Combined Otolaryngology Spring Meetings.
In our experience, we’ve found that the complication rate drops significantly with experience, not only of the surgeon, but of the whole tracheotomy team, Dr. Goldenberg said. We recommend adherence to contraindications and to a strict protocol, and emphasize that the learning curve is not just for the surgeon, but for the entire team that participates in performing these procedures.
Study Protocols
Dr. Goldenberg and his colleagues undertook a retrospective chart review of 318 consecutive PDTs performed in the intensive care unit between the years 2002 and 2005. Procedural and postoperative complications in an earlier group (Group A) were compared with those in the later group (Group B) for both frequency and severity.
All these procedures were done with the same method, using the Blue Rhino, Ciaglia method, single-pass percutaneous dilation tracheotomy set, Dr. Goldenberg said. All patients were intubated and their airway was under control by an experienced anesthesiologist during the procedure.
All patients underwent the procedure with local anesthetic and simultaneous video bronchoscopic visualization. For the majority of patients, the indication was prolonged intubation and mechanical ventilation, while a few were termed airway protection, pulmonary toilet, or partial obstruction.
Some Complications Reported
The overall complication rate was 5.9 percent, with severe complications being zero, Dr. Goldenberg reported. In Group A, which represented the first 159 patients in that series, there were 12 complications, whereas in Group B there were a total of seven complications.
In Group A, three patients experienced during surgery what we deemed equipment malfunction, which forced us to open another set, and cannulation was delayed, he said. There was one accidental extubation on the anesthesiologist’s side. There was one patient who had cardiopulmonary arrest during the procedure, although this was a very sick individual and it probably had nothing to do with the procedure itself.