Analysis of predisposing factors for complications of percutaneous tracheostomy

Since the turn of the century, percutaneous tracheostomy (PT) has become an alternative to the classic open technique and is an elective procedure in intensive care units at most centers. We conducted a prospective study to identify and quantify the complication rate with PT and to analyze this procedure's association with potential risk factors. Our study population was made up of 114 patients-83 men (72.8%) and 31 women (27.2%), aged 18 to 81 years (mean: 57 ± 15)-who underwent PT at our center over an 18-month period. We sought to determine if there were any associations between PT complications and sex, previous fibroscopy, cervical length, cervical risk factors, and general risk factors. Generally minor complications were noted in 15 patients (13.2%); 13 patients experienced hemorrhage, 1 exhibited subcutaneous emphysema, and 1 had a vagal reaction that resolved with medical treatment. Only 3 of these cases (2.6%) were considered to be clinically relevant: 1 hemorrhage (which was treated with ligation), the emphysema (which resolved spontaneously), and the vagal reaction (which resolved with medical treatment). Statistically, we found that PT complications were significantly correlated with two factors: coagulopathy (p = 0.015) and hemodynamic instability (p = 0.017). Even so, these complications were not clinically significant, and they resolved with conservative treatment measures. Given the low incidence and mild degree of these complications, we consider PT to be a safe procedure, even in patients with a high risk of hemorrhage or cervical anatomic difficulties.