HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (39) Citing Articles via Google Scholar Google Scholar Articles by Trottier, S. J. Articles by McNary, R. Search for Related Content PubMed PubMed Citation Articles by Trottier, S. J. Articles by McNary, R.

Posterior Tracheal Wall Perforation During Percutaneous Dilational Tracheostomy^*

An Investigation Into Its Mechanism and Prevention

^* From St. John's Mercy Medical Center (Drs. Trottier, Sakabu, Levine, Troop, and Thompson), St. Louis University, St. Louis, MO; the Medical Education and Research Institute (Dr. Hazard), University of Tennessee Center for the Health Sciences, Memphis, TN; and the Smiths Industries Medical Systems Portex, Inc. (Mr. McNary), Keene, NH. Supported in part by a grant from Smiths Industries Medical Systems (SIMS) Portex Inc, Keene, NH. Richard McNary is a full-time employee of SIMS Portex Inc. Patrick Hazard was a part-time paid consultant of SIMS Portex Inc.

Correspondence to: Steven J. Trottier, MD, St. John's Mercy Medical Center, Department of Critical Care Medicine, Tower B 5007, 621 S New Ballas Rd, St. Louis, MO 63141; e-mail: critcare{at}inlink.com

Objectives: Part 1: To describe the complication of posterior tracheal wall injury and perforation associated with the percutaneous dilational tracheostomy (PDT). Part 2: To determine the mechanism of posterior tracheal wall injury during PDT.

Design: Prospective observational study.

Subjects: Part 1: Medical-surgical ICU patients requiring tracheostomy. Part 2: Swine and cadaver models.

Interventions: Part 1: Consecutive medical-surgical ICU patients undergoing tracheostomy tube insertion via the percutaneous dilation technique with bronchoscopic guidance were enrolled in the study. Demographic data and complications were recorded. Part 2: Tracheostomy tubes were inserted via the percutaneous dilational technique in the swine model with concomitant bronchoscopic video recording from the proximal and distal airways. Tracheostomy tubes were inserted via the percutaneous dilational technique in the cadaver model followed by anatomic inspection of the airway.

Results: Part 1: Seven (29%) of 24 medical-surgical ICU patients sustained complications associated with PDT. Three patients (12.5%) sustained posterior tracheal wall perforations followed by the development of tension pneumothoraces. Part 2: The swine model demonstrated that posterior tracheal wall perforation may occur during PDT when the guiding catheter is withdrawn into the dilating catheters. Five-centimeter posterior tracheal wall mucosal lacerations occurred when the guidewire and the guiding catheter were not properly stabilized during PDT.

Conclusion: Percutaneous dilational tracheostomy was associated with a 29% complication rate in this observational study. Of concern was the high rate (12.5%) of posterior tracheal wall perforation. The swine and cadaver models suggest that posterior tracheal wall injury or perforation may occur if the guidewire and guiding catheter are not properly stabilized. To avoid posterior tracheal wall injury, the guidewire and guiding catheter should be firmly stabilized during PDT.

Key Words: complications • critically ill • fiberoptic bronchoscopy • guiding catheter • percutaneous dilational tracheostomy • posterior tracheal wall injury • posterior tracheal wall perforation

This article has been cited by other articles:

				S. Leinung, C. Mobius, H.-S. Hofmann, R. Ott, H. Ruffert, E. Schuster, and U. Eichfeld Iatrogenic tracheobronchial ruptures - treatment and outcomes Interactive CardioVascular and Thoracic Surgery, June 1, 2006; 5(3): 303 - 306. [Abstract] [Full Text] [PDF]

				A. Gomez-Caro Andres, F. J. Moradiellos Diez, P. Ausin Herrero, V. Diaz-Hellin Gude, E. Larru Cabrero, E. de Miguel Porch, and J. L. Martin De Nicolas Successful Conservative Management in Iatrogenic Tracheobronchial Injury Ann. Thorac. Surg., June 1, 2005; 79(6): 1872 - 1878. [Abstract] [Full Text] [PDF]

				M. Beiderlinden, M. Adamzik, and J. Peters Conservative Treatment of Tracheal Injuries Anesth. Analg., January 1, 2005; 100(1): 210 - 214. [Abstract] [Full Text] [PDF]

				N. Sengupta, K. L. Ang, D. Prakash, V. Ng, and S. J. George Twenty Months' Routine Use of a New Percutaneous Tracheostomy Set Using Controlled Rotating Dilation Anesth. Analg., July 1, 2004; 99(1): 188 - 192. [Abstract] [Full Text] [PDF]

				B. G. Fikkers, J. A. van Veen, J. G. Kooloos, P. Pickkers, F. J. A. van den Hoogen, B. Hillen, and J. G. van der Hoeven Emphysema and Pneumothorax After Percutaneous Tracheostomy: Case Reports and an Anatomic Study Chest, May 1, 2004; 125(5): 1805 - 1814. [Abstract] [Full Text] [PDF]

				K. H. Polderman, J. J. Spijkstra, R. de Bree, H. M.T. Christiaans, H. P.M.M. Gelissen, J. P.J. Wester, and A. R.J. Girbes Percutaneous Dilatational Tracheostomy in the ICU: Optimal Organization, Low Complication Rates, and Description of a New Complication Chest, May 1, 2003; 123(5): 1595 - 1602. [Abstract] [Full Text] [PDF]

				C. Byhahn, H.-J. Wilke, S. Halbig, V. Lischke, and K. Westphal Percutaneous Tracheostomy: Ciaglia Blue Rhino Versus the Basic Ciaglia Technique of Percutaneous Dilational Tracheostomy Anesth. Analg., October 1, 2000; 91(4): 882 - 886. [Abstract] [Full Text] [PDF]

				P. Ciaglia Differences in Percutaneous Dilational Tracheostomy Kits Chest, June 1, 2000; 117(6): 1823 - 1823. [Full Text] [PDF]

				D. P. Sandifer Percutaneous Dilational Tracheostomy Kits Chest, November 1, 1999; 116(5): 1498 - 1498. [Full Text] [PDF]