Long-term outcome after Griggs tracheostomy

Area of Science:

• Cardiothoracic Surgery
• Pulmonology
• Critical Care Medicine

Background:

• Percutaneous tracheostomy (PDT) is a common procedure in intensive care settings.
• Long-term outcomes, particularly laryngotracheal stenosis, require thorough evaluation.
• Assessing the impact of PDT on airway morphology is essential for patient care.

Purpose of the Study:

• To evaluate the incidence and severity of laryngotracheal stenoses in patients following percutaneous tracheostomy.
• To identify factors contributing to the development of tracheal stenosis post-PDT.
• To emphasize the importance of procedural technique in preventing airway complications.

Main Methods:

• A cohort of 162 patients undergoing PDT between 1997-2000 was retrospectively analyzed.
• Follow-up laryngotracheoscopy was performed on 38 long-term surviving patients (mean follow-up: 22 months).
• Planimetric quantification of laryngotracheal stenosis and assessment of tracheostomy site and cricoid cartilage integrity were conducted.

Main Results:

• Clinically significant tracheal stenosis was rare (1/38 patients).
• Endoscopic examination revealed asymptomatic tracheal stenosis (<25% narrowing) in 89.5% of patients.
• Suboptimal puncture site placement (between 1st-2nd tracheal rings in 31.6%) and cricoid lesions (15 patients) were common, correlating with higher stenosis rates.

Conclusions:

• Clinically relevant tracheal stenosis after PDT is primarily linked to the puncture site and tracheal fractures.
• Adequate endoscopic guidance and meticulous performance of PDT are critical for minimizing airway complications.
• Further research is needed to refine PDT techniques and ensure high-quality patient outcomes.