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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2009 Novembre;75(11):607-615
Outcomes Of Percutaneous Tracheostomy
Carrer S. 1, Basilico S. 1, Rossi S. 1, Bosu A. 1, Bernorio S. 2, Vaghi G. M. 1
1 Department of Critical Care Unit, G. Salvini Hospital, Hospital of Rho, Milan, Italy;
2 Department of Chest Care, G. Salvini Hospital, Hospital of Passirana, Milan, Italy
AIM: Percutaneous dilatational tracheostomy (PDT) is one of the most commonly performed procedures in critically ill patients receiving mechanical ventilation. Although many papers have compared different PDT techniques, few records on the outcome of tracheostomized patients after intensive care unit (ICU) discharge are available
METHODS: Prospective observational study to evaluate efficacy, safety and long-term consequences of PDT performed over a 6-year period (January 2002-December 2007) in a combined medical/surgical ICU in Rho, Milan, Italy. A total of 181 patients were RESULTS: The main endpoints that were examined were complications related to PDT and the final outcome of tracheostomized patients. Early complications included minor bleeding in 4 patients, stomal infection in 8 patients, and the occurrence of hypoxic/desaturation events during the procedure in 3 cases. Late complications included: tracheal stenosis in a single case, recurrent stomal granuloma in 2 cases, and tracheal mucosa injury caused by the endotracheal tube cuff in 3 patients. All patients who were decannulated late underwent bronchoscopic follow-up at 3, 6 and 12 months. Hospital discharge: of the 137 patients alive at the time of discharge from the hospital, 115 were decannulated (40 early decannulation, 75 late decannulation). In total, 22 patients were never decannulated (14 breathed spontaneously whereas 8 needed ventilator support). In the group of patients that were decannulated late, the mortality rate at 1 year was 20.6%.
CONCLUSIONS: PDT-related early complications without clinical consequences were observed. Conversely, late complications were infrequent but had significant clinical implications. Although late decannulation is the major risk for complications, in 83.9% of cases tracheostomy is only a temporary measure.