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

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

doi:10.1186/cc13085

journal article Open Access Oct 29, 2013

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

Marcel Simon Maria Metschke Stephan A Braune Klaus Püschel Stefan Kluge

Critical Care Vol. 17 No. 5 · Springer Science and Business Media LLC

View at Publisher Save 10.1186/cc13085

Abstract

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 A systematic literature search was performed and unpublished cases from our own departmental records were retrospectively analyzed.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.

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Details

Published: Oct 29, 2013
Vol/Issue: 17(5)
License: View

Authors

University Medical Center Hamburg–Eppendorf, Hamburg, Germany

Cite This Article

Marcel Simon, Maria Metschke, Stephan A Braune, et al. (2013). Death after percutaneous dilatational tracheostomy: a systematic review and analysis of risk factors. Critical Care, 17(5). https://doi.org/10.1186/cc13085

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

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