Tracheal lesion caused by percutaneous dilatational tracheostomy : a clinico-pathological study

To analyse the accuracy of cannula placement and the extent of tracheal lesions of the anterior tracheal wall after percutaneous dilatational tracheostomy (PDT). A clinico-pathological study of tracheal specimens following PDT. University hospital. Forty-two tracheal specimens of intensive care patients (24 male, 18 female; age: 23-70 years) who died unrelated to tracheostomy. Using tracheoscopic guidance, PDTs were performed by Ciaglia's method. Tracheal cannulas with outer diameters of 11-12 mm were used. The duration of cannulation ranged from 1 to 97 days (median: 10.5 days). PDTs were placed between the 1st and 4th tracheal rings in 32 cases, above the first ring in 7 cases and below the 4th in 3 cases. Twenty specimens showed a horizontal intercartilaginous rupture of the anterior tracheal wall, 12 tracheas additionally had fractures of tracheal rings and in 10 specimens defects of tracheal cartilage (range: 15 mm2-120 mm2) were found. The occurrence of tracheal defects was influenced by the height of puncture (p