Death after percutaneous dilatational tracheostomy: a systematic review and analysis of risk factors

Marcel Simon, Maria Metschke, Stephan A Braune, Klaus Püschel, Stefan Kluge, Marcel Simon, Maria Metschke, Stephan A Braune, Klaus Püschel, Stefan Kluge

Abstract

Introduction: Since the introduction and widespread acceptance of percutaneous techniques in the intensive care unit (ICU) setting, the number of critically ill patients undergoing tracheostomy has steadily increased. However, this procedure can be associated with major complications, including death. The purpose of this study is to estimate the incidence and analyze the causes of lethal complications due to percutaneous dilatational tracheostomy (PDT).

Methods: We analyzed cases of lethal outcome due to complications from PDT including cases published between 1985 and April 2013. A systematic literature search was performed and unpublished cases from our own departmental records were retrospectively analyzed.

Results: A total of 71 cases of lethal outcome following PDT were identified including 68 published cases and 3 of our own patients. The incidence of lethal complications was calculated to be 0.17%. Of the fatal complications, 31.0% occurred during the procedure and 49.3% within seven days of the procedure. The main causes of death were: hemorrhage (38.0%), airway complications (29.6%), tracheal perforation (15.5%), and pneumothorax (5.6%). We found specific risk factors for complications in 73.2% of patients, 25.4% of patients had more than one risk factor. Bronchoscopic guidance was used in only 46.5% of cases.

Conclusions: According to this analysis, PDT-related death occurs in 1 out of 600 patients receiving a PDT. Careful patient selection, bronchoscopic guidance, and securing the tracheal cannula with sutures are likely to reduce complication rates.

Figures

Figure 1
Figure 1
Process of case selection. *[12-14]. **[15,16].

References

    1. Cox CE, Carson SS, Holmes GM, Howard A, Carey TS. Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993-2002. Crit Care Med. 2004;17:2219–2226.
    1. Simpson TP, Day CJ, Jewkes CF, Manara AR. The impact of percutaneous tracheostomy on intensive care unit practice and training. Anaesthesia. 1999;17:186–189. doi: 10.1046/j.1365-2044.1999.00667.x.
    1. Needham DM, Bronskill SE, Calinawan JR, Sibbald WJ, Pronovost PJ, Laupacis A. Projected incidence of mechanical ventilation in Ontario to 2026: Preparing for the aging baby boomers. Crit Care Med. 2005;17:574–579. doi: 10.1097/01.CCM.0000155992.21174.31.
    1. Zilberberg MD, de Wit M, Pirone JR, Shorr AF. Growth in adult prolonged acute mechanical ventilation: implications for healthcare delivery. Crit Care Med. 2008;17:1451–1455. doi: 10.1097/CCM.0b013e3181691a49.
    1. Wang F, Wu Y, Bo L, Lou J, Zhu J, Chen F, Li J, Deng X. The timing of tracheotomy in critically ill patients undergoing mechanical ventilation: a systematic review and meta-analysis of randomized controlled trials. Chest. 2011;17:1456–1465. doi: 10.1378/chest.11-2024.
    1. Kluge S, Baumann HJ, Maier C, Klose H, Meyer A, Nierhaus A, Kreymann G. Tracheostomy in the intensive care unit: a nationwide survey. Anesth Analg. 2008;17:1639–1643. doi: 10.1213/ane.0b013e318188b818.
    1. Freeman BD, Morris PE. Tracheostomy practice in adults with acute respiratory failure. Crit Care Med. 2012;17:2890–2896. doi: 10.1097/CCM.0b013e31825bc948.
    1. Das P, Zhu H, Shah RK, Roberson DW, Berry J, Skinner ML. Tracheotomy-related catastrophic events: results of a national survey. Laryngoscope. 2012;17:30–37. doi: 10.1002/lary.22453.
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;17:e1000100. doi: 10.1371/journal.pmed.1000100.
    1. Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy. A new simple bedside procedure: preliminary report. Chest. 1985;17:715–719. doi: 10.1378/chest.87.6.715.
    1. Braune S, Kluge S. [Die perkutane Dilatationstracheotomie] Dtsch Med Wochenschr. 2011;17:1265–1269. doi: 10.1055/s-0031-1280549.
    1. Dempsey GA, Grant CA, Jones TM. Percutaneous tracheostomy: a 6 year prospective evaluation of the single tapered dilator technique. Br J Anaesth. 2010;17:782–788. doi: 10.1093/bja/aeq238.
    1. Hill BB, Zweng TN, Maley RH, Charash WE, Toursarkissian B, Kearney PA. Percutaneous dilational tracheostomy: report of 356 cases. J Trauma. 1996;17:238–243. doi: 10.1097/00005373-199608000-00007.
    1. Toursarkissian B, Zweng TN, Kearney PA, Pofahl WE, Johnson SB, Barker DE. Percutaneous dilational tracheostomy: report of 141 cases. Ann Thorac Surg. 1994;17:862–867. doi: 10.1016/0003-4975(94)90191-0.
    1. Cobean R. Personal communication.
    1. Byhahn C. Personal communication.
    1. Hutchinson RC, Mitchell RD. Life-threatening complications from percutaneous dilational tracheostomy. Crit Care Med. 1991;17:118–120. doi: 10.1097/00003246-199101000-00027.
    1. Cokis C, Towler S. Tracheo-innominate fistula after initial percutaneous tracheostomy. Anaesth Intensive Care. 2000;17:566–569.
    1. Hürter H, Post-Stanke A. [Tödliche Gefäßarrosion nach Dilatationstracheotomie] Anasthesiol Intensivmed Notfallmed Schmerzther. 2000;17:658–660. doi: 10.1055/s-2000-7362.
    1. Drage SM, Pac Soo C, Dexter T. Delayed presentation of tracheo-oesophageal fistula following percutaneous dilatational tracheostomy. Anaesthesia. 2002;17:932–933.
    1. Maeda K, Ninomiya M, Moyairi T, Morota T, Kitamura R, Takamoto S. Mediastinitis after percutaneous dilatational tracheostomy. Thorac Cardiovasc Surg. 2002;17:123–124. doi: 10.1055/s-2002-26688.
    1. Soubirou JL, Puidupin A, Augeul G, Leclerc T, Combourieu E, Patrigeon RG, Escarment J. [Complication sévère après une trachéotomie translaryngée] Ann Fr Anesth Reanim. 2002;17:728–730. doi: 10.1016/S0750-7658(02)00783-9.
    1. Ryan DW, Kilner AJ. Another death after percutaneous dilational tracheostomy. Br J Anaesth. 2003;17:925–926. doi: 10.1093/bja/aeg649.
    1. Shlugman D, Satya-Krishna R, Loh L. Acute fatal haemorrhage during percutaneous dilatational tracheostomy. Br J Anaesth. 2003;17:517–520. doi: 10.1093/bja/aeg074.
    1. McCormick B, Manara AR. Mortality from percutaneous dilatational tracheostomy. A report of three cases. Anaesthesia. 2005;17:490–495. doi: 10.1111/j.1365-2044.2005.04137.x.
    1. Grant CA, Dempsey G, Harrison J, Jones T. Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical review. Br J Anaesth. 2006;17:127–131.
    1. Rosolski T. [Spannungspneumothorax Nach Punktionstracheotomie] J Anaesth Intensivbehandlung. 2006;17:36.
    1. Ayoub OM, Griffiths MV. Aortic arch laceration: A lethal complication after percutaneous tracheostomy. Laryngoscope. 2007;17:176–178. doi: 10.1097/01.mlg.0000244181.01612.a6.
    1. Zehlicke T, Dommerich S, Rummel J. [Letale Blutung aus dem Truncus brachiocephalicus - Spätkomplikation nach Fehleinschätzung eines Dilatationstracheostomas bei rudimentärer Halsrippe] Laryngorhinootologie. 2007;17:655–659. doi: 10.1055/s-2006-945024.
    1. Wang P-K, Yen P-S, Shyr M-H, Chen T-Y, Chen A, Liu H-T. Endovascular repair of tracheo-innominate artery fistula. Acta Anaesthesiol Taiwan. 2009;17:36–39. doi: 10.1016/S1875-4597(09)60019-9.
    1. Hoiting O, van den Brule J, van Zwam PH. Late fatal bleeding after percutaneous dilatational tracheostomy. Neth J Crit Care. 2010;17:335–337. doi: 10.1186/cc8567.
    1. Gilbey P. Fatal complications of percutaneous dilatational tracheostomy. Am J Otolaryngol. 2012;17:770–773.
    1. Ivatury R, Siegel JH, Stahl WM, Simon R, Scorpio R, Gens DR. Percutaneous tracheostomy after trauma and critical illness. J Trauma. 1992;17:133–140.
    1. Cobean R, Beals M, Moss C. Percutaneous dilatational tracheostomy: a safe, cost-effective bedside procedure. Arch Surg. 1996;17:265–271. doi: 10.1001/archsurg.1996.01430150043008.
    1. van Heurn LW, van Geffen GJ, Brink PR. Clinical experience with percutaneous dilatational tracheostomy: report of 150 cases. Eur J Surg. 1996;17:531–535.
    1. Thompson EC, Fernandez LG, Norwood S, Wilkins H, Vallina VL. Percutaneous dilatational tracheostomy in a community hospital setting. South Med J. 2001;17:208–211. doi: 10.1097/00007611-200102000-00008.
    1. Pandit RA, Jacques TC. Audit of over 500 percutaneous dilational tracheostomies. Crit Care Resusc. 2006;17:146–150.
    1. Klein M, Agassi R, Shapira A-R, Kaplan DM, Koiffman L, Weksler N. Can intensive care physicians safely perform percutaneous dilational tracheostomy? An analysis of 207 cases. Isr Med Assoc J. 2007;17:717–719.
    1. Dennis BM, Eckert MJ, Gunter OL, Morris JA, May AK. Safety of bedside percutaneous tracheostomy in the critically ill: evaluation of more than 3,000 procedures. J Am Coll Surg. 2013;17:858–867. doi: 10.1016/j.jamcollsurg.2012.12.017.
    1. Toye FJ, Weinstein JD. Clinical experience with percutaneous tracheostomy and cricothyroidotomy in 100 patients. J Trauma. 1986;17:1034–1040. doi: 10.1097/00005373-198611000-00013.
    1. Marelli D, Paul A, Manolidis S, Walsh G, Odim JN, Burdon TA, Shennib H, Vestweber KH, Fleiszer DM, Mulder DS. Endoscopic guided percutaneous tracheostomy: early results of a consecutive trial. J Trauma. 1990;17:433–435. doi: 10.1097/00005373-199004000-00012.
    1. Wang MB, Berke GS, Ward PH, Calcaterra TC, Watts D. Early experience with percutaneous tracheotomy. Laryngoscope. 1992;17:157–162.
    1. Friedman Y, Mayer AD. Bedside percutaneous tracheostomy in critically ill patients. Chest. 1993;17:532–535. doi: 10.1378/chest.104.2.532.
    1. Cole IE. Elective percutaneous (Rapitrac) tracheotomy: results of a prospective trial. Laryngoscope. 1994;17:1271–1275.
    1. Barba C, Angood P, Kauder D, Latenser B. Bronchoscopic guidance makes percutaneous tracheostomy a safe, cost-effective, and easy-to-teach procedure. Surgery. 1995;17:879–883. doi: 10.1016/S0039-6060(05)80279-X.
    1. Muhl E, Franke C, BRUCH HP. [Verbesserte Technik der Dilatationstracheostomie und erste Ergebnisse] Anasthesiol Intensivmed Notfallmed Schmerzther. 1995;17:497–500. doi: 10.1055/s-2007-996538.
    1. Joosten U, Sturbeck K, Hohlbach G. [Die Punktionstracheotomie beim langzeitbeatmeten Intensivpatienten] Langenbecks Arch Chir Suppl Kongressbd. 1996;17:356–359.
    1. Marx WH, Ciaglia P, Graniero KD. Some important details in the technique of percutaneous dilatational tracheostomy via the modified Seldinger technique. Chest. 1996;17:762–766. doi: 10.1378/chest.110.3.762.
    1. Berrouschot J, Oeken J, Schneider D. Perioperative complications of percutaneous dilational tracheostomy. Laryngoscope. 1997;17:1538–1544. doi: 10.1097/00005537-199711000-00021.
    1. Walz MK, Peitgen K, Thürauf N, Trost HA, Wolfhard U, Sander A, Ahmadi C, Eigler FW. Percutaneous dilatational tracheostomy–early results and long-term outcome of 326 critically ill patients. Intensive Care Med. 1998;17:685–690. doi: 10.1007/s001340050645.
    1. Suh RH, Margulies DR, Hopp ML, Ault M, Shabot MM. Percutaneous dilatational tracheostomy: still a surgical procedure. Am Surg. 1999;17:982–986.
    1. Escarment J, Suppini A, Sallaberry M, Kaiser E, Cantais E, Palmier B, Quinot JF. Percutaneous tracheostomy by forceps dilation: report of 162 cases. Anaesthesia. 2000;17:125–130. doi: 10.1046/j.1365-2044.2000.055002125.x.
    1. Kearney PA, Griffen MM, Ochoa JB, Boulanger BR, Tseui BJ, Mentzer RM. A single-center 8-year experience with percutaneous dilational tracheostomy. Ann Surg. 2000;17:701–709. doi: 10.1097/00000658-200005000-00010.
    1. Lim JW, Friedman M, Tanyeri H, Lazar A, Caldarelli DD. Experience with percutaneous dilational tracheostomy. Ann Otol Rhinol Laryngol. 2000;17:791–796.
    1. Norwood S, Vallina VL, Short K, Saigusa M, Fernandez LG, McLarty JW. Incidence of tracheal stenosis and other late complications after percutaneous tracheostomy. Ann Surg. 2000;17:233–241. doi: 10.1097/00000658-200008000-00014.
    1. Tan C, Lee H. Percutaneous dilational tracheostomy - a 3 year experience in a general hospital in Malaysia. Med J Malaysia. 2004;17:591–597.
    1. Byhahn C, Lischke V, Meininger D, Halbig S, Westphal K. Peri-operative complications during percutaneous tracheostomy in obese patients. Anaesthesia. 2005;17:12–15. doi: 10.1111/j.1365-2044.2004.03707.x.
    1. Chiu C-T, Chung Y-H, Lu H-I, Lin M-C. Weaning of long-term mechanically-ventilated patients following video bronchoscopy-guided percutaneous dilatational tracheostomy. Chang Gung Med J. 2005;17:829–836.
    1. Páez M, Buisán F, Almaraz A, Martínez-Martínez A, Muñoz F. Percutaneous tracheotomy with the Ciaglia Blue Rhino technique: a critical analysis after 1 year. Rev Esp Anestesiol Reanim. 2005;17:466–473.
    1. Porter JM, Ivatury RR. Preferred route of tracheostomy–percutaneous versus open at the bedside: a randomized, prospective study in the surgical intensive care unit. Am Surg. 1999;17:142–146.
    1. Massick DD, Yao S, Powell DM, Griesen D, Hobgood T, Allen JN, Schuller DE. Bedside tracheostomy in the intensive care unit: a prospective randomized trial comparing open surgical tracheostomy with endoscopically guided percutaneous dilational tracheotomy. Laryngoscope. 2001;17:494–500. doi: 10.1097/00005537-200103000-00021.
    1. Kluge S, Meyer A, Kühnelt P, Baumann HJ, Kreymann G. Percutaneous tracheostomy is safe in patients with severe thrombocytopenia. Chest. 2004;17:547–551. doi: 10.1378/chest.126.2.547.
    1. Australian and New Zealand Intensive Care Society. Percutaneous Dilatational Tracheostomy Consensus Statement. 2010.
    1. Kollig E, Heydenreich U, Roetman B, Hopf F, Muhr G. Ultrasound and bronchoscopic controlled percutaneous tracheostomy on trauma ICU. Injury. 2000;17:663–668. doi: 10.1016/S0020-1383(00)00094-2.
    1. Rajajee V, Fletcher JJ, Rochlen LR, Jacobs TL. Real-time ultrasound-guided percutaneous dilatational tracheostomy: a feasibility study. Crit Care. 2011;17:R67. doi: 10.1186/cc10047.
    1. Otchwemah R, Defosse J, Wappler F, Sakka SG. Percutaneous dilatation tracheostomy in the critically ill: use of ultrasound to detect an aberrant course of the brachiocephalic trunk. J Cardiothorac Vasc Anesth. 2012;17:e72–e73. doi: 10.1053/j.jvca.2012.06.005.
    1. Rudas M, Seppelt I. Safety and efficacy of ultrasonography before and during percutaneous dilatational tracheostomy in adult patients: a systematic review. Crit Care Resusc. 2012;17:297–301.
    1. Braune S, Kluge S. Update Tracheotomie. Med Klin Intensivmed Notfmed. 2012;17:543–547. doi: 10.1007/s00063-012-0089-y.
    1. De Leyn P, Bedert L, Delcroix M, Depuydt P, Lauwers G, Sokolov Y, Van Meerhaeghe A, Van Schil P, Belgian Association of Pneumology and Belgian Association of Cardiothoracic Surgery. Tracheotomy: clinical review and guidelines. Eur J Cardiothorac Surg. 2007. pp. 412–421.
    1. Higgins KM, Punthakee X. Meta-analysis comparison of open versus percutaneous tracheostomy. Laryngoscope. 2007;17:447–454. doi: 10.1097/01.mlg.0000251585.31778.c9.
    1. Halum SL, Ting JY, Plowman EK, Belafsky PC, Harbarger CF, Postma GN, Pitman MJ, LaMonica D, Moscatello A, Khosla S, Cauley CE, Maronian NC, Melki S, Wick C, Sinacori JT, White Z, Younes A, Ekbom DC, Sardesai MG, Merati AL. A multi-institutional analysis of tracheotomy complications. Laryngoscope. 2012;17:38–45. doi: 10.1002/lary.22364.
    1. Beiderlinden M, Karl Walz M, Sander A, Groeben H, Peters J. Complications of bronchoscopically guided percutaneous dilational tracheostomy: beyond the learning curve. Intensive Care Med. 2002;17:59–62. doi: 10.1007/s00134-001-1151-z.
    1. Byhahn C, Wilke HJ, Halbig S, Lischke V, Westphal K. Percutaneous tracheostomy: ciaglia blue rhino versus the basic ciaglia technique of percutaneous dilational tracheostomy. Anesth Analg. 2000;17:882–886. doi: 10.1097/00000539-200010000-00021.
    1. Thant M, Samuel T. Posterior tracheal wall tear with PercuTwist. Anaesthesia. 2002;17:507–508.
    1. Eibling DE, Roberson DW. Managing tracheotomy risk: time to look beyond hospital discharge. Laryngoscope. 2012;17:23–24. doi: 10.1002/lary.22498.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel