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Relative contraindications for percutaneous tracheostomy: from the surgeons' perspective
Chien-Sheng Huang1, Pin-Tarng Chen, Shu-Hui Cheng
1Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, 201 Section 2 Shih-Pai Road, Taipei, Taiwan, huangcs@vghtpe.gov.tw.
Surgery Today
|January 31, 2013
Summary
Percutaneous tracheostomy (PT) is feasible in patients with relative contraindications, but requires careful consideration. Surgeons experienced in standard tracheostomy can safely perform PT, with attention to potential instrument failure and bleeding risks.
Area of Science:
- Critical Care Medicine
- Surgical Procedures
- Airway Management
Background:
- Percutaneous tracheostomy (PT) is a widely accepted bedside procedure.
- Reports of contraindications have led to a decline in PT popularity.
- Surgeons experienced in standard tracheostomy may offer a solution.
Purpose of the Study:
- To evaluate perioperative comorbidities of PT in patients with relative contraindications.
- To compare outcomes between patients with relative contraindications (RC) and normal conditions (NC).
Main Methods:
- Prospective data collection and analysis of consecutive PTs.
- Performed in intensive care units by experienced surgeons.
Main Results:
- No procedure-related mortality observed.
- Similar rates of hemodynamic instability and wound infection between RC and NC groups.
- Higher incidence of instrument failure and procedure failure in the RC group.
- Increased bleeding events in patients with coagulopathy and neck anatomical difficulty.
Conclusions:
- PT can be considered for patients with relative contraindications on an individual basis.
- Careful attention to potential instrument failure and bleeding is crucial for high-risk patients.
- Experienced surgical performance is key to managing PT in complex cases.
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