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Late complications of percutaneous dilatational tracheotomy
L W van Heurn1, R Goei, I de Ploeg
1Department of Surgery, De Wever Hospital, Heerlen, The Netherlands.
Study Objective:
To assess the late complications of percutaneous dilatational tracheotomy, particularly the incidence of tracheal stenosis and voice changes.
Design:
Prospective descriptive clinical study.
Setting:
Teaching hospital, the Netherlands.
Patients:
Eighty consecutive patients who were successfully decannulated after percutaneous tracheotomy.
Measurements And Results:
Fourteen patients died after decannulation, of tracheotomy-unrelated causes. Sixty-six patients were followed up 3 to 39 months after decannulation (mean, 16 months). Fifty-four patients underwent tomography of the trachea. In 14 patients (26%), there was tracheal narrowing of more than 10%. Data analysis showed that these stenoses were operator dependent (p = 0.03). Voice changes, found in 13 (21%) of 61 patients, were major in 1 and minor in 12. Scars were generally cosmetically acceptable. Retraction of the scar, seen in 13 (19%) of 66 patients, was related to the duration of cannulation (p = 0.002). A persistent tracheocutaneous fistula was present in two patients.
Conclusions:
The incidence of tracheal stenosis after percutaneous dilatational tracheotomy is low compared with conventional tracheotomy. Experience with the technique is important to avoid late complications.