The number of critically ill patients undergoing percutaneous dilatational tracheostomy (PDT) has increased in recent years. The procedure is not without risk and can be associated with major complications, including death. Prompted by three fatalities in their own department, researchers in Germany carried out a systematic review to determine the incidence of fatal complications of PDT. All published cases of death following PDT published up to April 2013 were identified. Including their own three unpublished cases, 71 cases of death due to PDT were identified, equating to an incidence of 1 in 600 patients. The most common cause of death was tracheostomy related hemorrhage, followed by airway complications. In 73.2 percent of cases specific known risk factors were identified (e.g. lack of bronchoscopic guidance, low tracheostomy site, coagulopathy and recent neck surgery).
This study highlights the importance of careful patient selection for PDT, the use of bronchoscopic guidance, and securing the tracheal cannula with sutures.
Written by Stephanie Harriman, Deputy Medical Editor for BioMed Central.
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