gms | German Medical Science

Dilatational percutaneous tracheostomy (PDT) and translaryngeal dilatatonal tracheostomy (TTL) are time and cost effective, also the procedure is usually safe and not invasive. Normally PDT is only used in pereselected patients. But there is a tendency to perform increasing numbers of PDT, especially in intensive care units of non- surgical departments.

In cooperation with several Hospitals and different departments we reviewed 25 cases in which surgery was needed to stabilize complications after PDT. The complications, as well as the patients history were analyzed. It was possible to sort the patients into two bigger groups. In the first group the decision to perform PDT did not respect the fact that long time ventilation and airway assistance was needed. So chronic inflammation and granulation required surgical procedures. In the second group the complications were caused by difficult anatomy and sometimes wrong handling of the PDT procedure. E. g. we observed several cases with a tracheostomy channel way to high or to low.

As a conclusion we found that PDT is often performed after insufficient selection of the patient. Complications are sometimes grave and cause longtime problems. We suggest a strict selection of patients before planning PDT and ask for individual and specialized planning of all tracheostomy procedures. Only a team approach, including ENT surgeons, will serve the interests of the patient in the best way.