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Fatal complications of percutaneous dilatational tracheostomy

Peter Gilbey1

  • 1The Otolaryngology, Head and Neck Surgery Unit, Ziv Medical Center, Zefat, Israel. peter.g@ziv.health.gov.il

American Journal of Otolaryngology
|August 28, 2012
PubMed
Abstract

Insights

Fatal complications from percutaneous dilatational tracheostomy (PDT) are rare, with vascular injury being the most common cause. This study highlights a unique nonvascular fatal complication and reviews existing literature to improve patient safety during PDT procedures.

Area of Science:

  • Critical Care Medicine
  • Surgical Procedures
  • Patient Safety

Background:

  • Percutaneous dilatational tracheostomy (PDT) is a common procedure with a low risk of fatal complications.
  • Intraoperative fatal complications during PDT are exceptionally rare.
  • Vascular injury is the predominant cause of mortality associated with PDT.

Observation:

  • This report details a unique, previously undocumented fatal nonvascular intraoperative complication during PDT.
  • A comprehensive review of all reported fatal complications following PDT was conducted.
  • Analysis aimed to identify common causes of death and propose preventative strategies.

Findings:

  • Fatal complications directly related to PDT technique are infrequent in medical literature.
  • The vast majority of reported fatal outcomes stem from vascular injury during the procedure.
  • Preoperative ultrasound or conversion to open surgical tracheostomy is recommended if vascular pulsation is detected.

Implications:

  • Caution is advised for patients with prior neck surgery, radiotherapy, or complex neck anatomy.
  • In anticipated difficult procedures or intubations, performing surgical tracheostomy directly may be safer than attempting PDT.
  • Implementing these recommendations can enhance patient safety and reduce mortality risks associated with PDT.

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