Prospective Observational Study of Postoperative Complications after Percutaneous Dilatational or Surgical Tracheostomy in Critically Ill Patients
Objective: To assess and describe postoperative complications of single dilator percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) in a large series of critically ill patients. Methods: A prospective observational study was conducted in 1163 critically ill patients in a univ...
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| Veröffentlicht in: | Critical care and resuscitation 2009-12, Vol.11 (4), p.244-249 |
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| creator | Barbetti, Julie K Nichol, Alistair D Choate, Kim R Bailey, Michael J Lee, Geraldine A Cooper, D James |
| description | Objective: To assess and describe postoperative complications of single dilator percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) in a large series of critically ill patients. Methods: A prospective observational study was conducted in 1163 critically ill patients in a universityaffiliated tertiary referral hospital between 2002 and 2007. PDT was the procedure of choice for all critically ill patients requiring tracheostomy except for those with an anatomic abnormality or refractory coagulopathy, who underwent ST. Demographic and postoperative complication data were collected in a web-based database. Results: 913 patients (79%) underwent PDT at the bedside in the ICU, and 250 (21%) underwent ST in the operating theatre. The tracheostomy tube was larger, and the duration of tracheostomy cannulation was shorter after PDT than after ST. The postoperative complication rate for PDT was 9.6% compared with 19.6% for ST (P |
| doi_str_mv | 10.1016/S1441-2772(23)01282-6 |
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Methods: A prospective observational study was conducted in 1163 critically ill patients in a universityaffiliated tertiary referral hospital between 2002 and 2007. PDT was the procedure of choice for all critically ill patients requiring tracheostomy except for those with an anatomic abnormality or refractory coagulopathy, who underwent ST. Demographic and postoperative complication data were collected in a web-based database. Results: 913 patients (79%) underwent PDT at the bedside in the ICU, and 250 (21%) underwent ST in the operating theatre. The tracheostomy tube was larger, and the duration of tracheostomy cannulation was shorter after PDT than after ST. The postoperative complication rate for PDT was 9.6% compared with 19.6% for ST (P<0.001). Tracheal tube obstruction and displacement were significantly less frequent after PDT (obstruction 1.0% for PDT v 3.6% for ST, P = 0.007; displacement, 1.3% for PDT v 4.8% for ST, P = 0.002). Conclusions: In a large heterogeneous group of critically ill patients, single dilator PDT was safe and had few postoperative complications. Although ST was used in higher-risk patients, those who underwent PDT were more likely to receive a larger-sized tracheostomy tube; they were also less likely to experience obstruction or displacement of the postoperative tracheostomy tube. These differences are probably related to a combination of patient selection, smaller, shorter tracheostomy tubes, and larger tissue incision size with ST.</description><identifier>ISSN: 1441-2772</identifier><identifier>DOI: 10.1016/S1441-2772(23)01282-6</identifier><identifier>PMID: 20001871</identifier><language>eng</language><publisher>Australia</publisher><subject>Care ; Critical Care ; Critically ill ; Female ; Humans ; Incidence ; Intensive care nursing ; Intensive Care Units ; Male ; Medical care ; Middle Aged ; Outcome assessment (Medical care) ; Patient Selection ; Patients ; Postoperative Hemorrhage - epidemiology ; Prospective Studies ; Surgical Wound Infection - epidemiology ; Tracheostomy - adverse effects ; Tracheostomy - methods ; Tracheostomy - statistics & numerical data ; Tracheotomy ; Victoria - epidemiology</subject><ispartof>Critical care and resuscitation, 2009-12, Vol.11 (4), p.244-249</ispartof><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c436t-d99f5fa968b94cdbbda6eea4e3fd44950cc35e9b7d13eb82786fe8ab77313d323</citedby><cites>FETCH-LOGICAL-c436t-d99f5fa968b94cdbbda6eea4e3fd44950cc35e9b7d13eb82786fe8ab77313d323</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27929,27930</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20001871$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Barbetti, Julie K</creatorcontrib><creatorcontrib>Nichol, Alistair D</creatorcontrib><creatorcontrib>Choate, Kim R</creatorcontrib><creatorcontrib>Bailey, Michael J</creatorcontrib><creatorcontrib>Lee, Geraldine A</creatorcontrib><creatorcontrib>Cooper, D James</creatorcontrib><title>Prospective Observational Study of Postoperative Complications after Percutaneous Dilatational or Surgical Tracheostomy in Critically Ill Patients</title><title>Critical care and resuscitation</title><addtitle>Crit Care Resusc</addtitle><description>Objective: To assess and describe postoperative complications of single dilator percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) in a large series of critically ill patients. Methods: A prospective observational study was conducted in 1163 critically ill patients in a universityaffiliated tertiary referral hospital between 2002 and 2007. PDT was the procedure of choice for all critically ill patients requiring tracheostomy except for those with an anatomic abnormality or refractory coagulopathy, who underwent ST. Demographic and postoperative complication data were collected in a web-based database. Results: 913 patients (79%) underwent PDT at the bedside in the ICU, and 250 (21%) underwent ST in the operating theatre. The tracheostomy tube was larger, and the duration of tracheostomy cannulation was shorter after PDT than after ST. The postoperative complication rate for PDT was 9.6% compared with 19.6% for ST (P<0.001). Tracheal tube obstruction and displacement were significantly less frequent after PDT (obstruction 1.0% for PDT v 3.6% for ST, P = 0.007; displacement, 1.3% for PDT v 4.8% for ST, P = 0.002). Conclusions: In a large heterogeneous group of critically ill patients, single dilator PDT was safe and had few postoperative complications. Although ST was used in higher-risk patients, those who underwent PDT were more likely to receive a larger-sized tracheostomy tube; they were also less likely to experience obstruction or displacement of the postoperative tracheostomy tube. These differences are probably related to a combination of patient selection, smaller, shorter tracheostomy tubes, and larger tissue incision size with ST.</description><subject>Care</subject><subject>Critical Care</subject><subject>Critically ill</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intensive care nursing</subject><subject>Intensive Care Units</subject><subject>Male</subject><subject>Medical care</subject><subject>Middle Aged</subject><subject>Outcome assessment (Medical care)</subject><subject>Patient Selection</subject><subject>Patients</subject><subject>Postoperative Hemorrhage - epidemiology</subject><subject>Prospective Studies</subject><subject>Surgical Wound Infection - epidemiology</subject><subject>Tracheostomy - adverse effects</subject><subject>Tracheostomy - methods</subject><subject>Tracheostomy - statistics & numerical data</subject><subject>Tracheotomy</subject><subject>Victoria - epidemiology</subject><issn>1441-2772</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kc1u1DAUhb0A0VJ4BJB3wCLgv7GdJRooVKrUkaZI7CzHuWldOXGwnUrzGjxxk0w7K0s-371H9xyEPlDylRIqv-2pELRiSrHPjH8hlGlWyVfo_PR9ht7m_EAIq4VUb9AZI4RQreg5-r9LMY_gin8EfNNkSI-2-DjYgPdlag84dngXc4kjJLtC29iPwbuVyth2BRLeQXJTsQPEKeMfPtjysiQmvJ_S3cwHfJusu4dlWX_AfsDb5MsihAO-CgHv5hkYSn6HXnc2ZHj__F6gP5c_b7e_q-ubX1fb79eVE1yWqq3rbtPZWuqmFq5tmtZKACuAd60Q9YY4xzdQN6qlHBrNlJYdaNsoxSlvOeMX6NNx75jivwlyMb3PDkI43mEU54poJdVMbo6km8PKCTozJt_bdDCUmKUBszZglqgN42ZtwMh57uOzw9T00J6mXuKfgb9HIPW-GBdDWJqYc32wJZsMNrl744curnpMd6aN3tgmL8acz8YnURNONdE1F4wzIvgToLCn5Q</recordid><startdate>20091201</startdate><enddate>20091201</enddate><creator>Barbetti, Julie K</creator><creator>Nichol, Alistair D</creator><creator>Choate, Kim R</creator><creator>Bailey, Michael J</creator><creator>Lee, Geraldine A</creator><creator>Cooper, D James</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20091201</creationdate><title>Prospective Observational Study of Postoperative Complications after Percutaneous Dilatational or Surgical Tracheostomy in Critically Ill Patients</title><author>Barbetti, Julie K ; Nichol, Alistair D ; Choate, Kim R ; Bailey, Michael J ; Lee, Geraldine A ; Cooper, D James</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c436t-d99f5fa968b94cdbbda6eea4e3fd44950cc35e9b7d13eb82786fe8ab77313d323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Care</topic><topic>Critical Care</topic><topic>Critically ill</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Intensive care nursing</topic><topic>Intensive Care Units</topic><topic>Male</topic><topic>Medical care</topic><topic>Middle Aged</topic><topic>Outcome assessment (Medical care)</topic><topic>Patient Selection</topic><topic>Patients</topic><topic>Postoperative Hemorrhage - epidemiology</topic><topic>Prospective Studies</topic><topic>Surgical Wound Infection - epidemiology</topic><topic>Tracheostomy - adverse effects</topic><topic>Tracheostomy - methods</topic><topic>Tracheostomy - statistics & numerical data</topic><topic>Tracheotomy</topic><topic>Victoria - epidemiology</topic><toplevel>online_resources</toplevel><creatorcontrib>Barbetti, Julie K</creatorcontrib><creatorcontrib>Nichol, Alistair D</creatorcontrib><creatorcontrib>Choate, Kim R</creatorcontrib><creatorcontrib>Bailey, Michael J</creatorcontrib><creatorcontrib>Lee, Geraldine A</creatorcontrib><creatorcontrib>Cooper, D James</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care and resuscitation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Barbetti, Julie K</au><au>Nichol, Alistair D</au><au>Choate, Kim R</au><au>Bailey, Michael J</au><au>Lee, Geraldine A</au><au>Cooper, D James</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prospective Observational Study of Postoperative Complications after Percutaneous Dilatational or Surgical Tracheostomy in Critically Ill Patients</atitle><jtitle>Critical care and resuscitation</jtitle><addtitle>Crit Care Resusc</addtitle><date>2009-12-01</date><risdate>2009</risdate><volume>11</volume><issue>4</issue><spage>244</spage><epage>249</epage><pages>244-249</pages><issn>1441-2772</issn><abstract>Objective: To assess and describe postoperative complications of single dilator percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) in a large series of critically ill patients. Methods: A prospective observational study was conducted in 1163 critically ill patients in a universityaffiliated tertiary referral hospital between 2002 and 2007. PDT was the procedure of choice for all critically ill patients requiring tracheostomy except for those with an anatomic abnormality or refractory coagulopathy, who underwent ST. Demographic and postoperative complication data were collected in a web-based database. Results: 913 patients (79%) underwent PDT at the bedside in the ICU, and 250 (21%) underwent ST in the operating theatre. The tracheostomy tube was larger, and the duration of tracheostomy cannulation was shorter after PDT than after ST. The postoperative complication rate for PDT was 9.6% compared with 19.6% for ST (P<0.001). Tracheal tube obstruction and displacement were significantly less frequent after PDT (obstruction 1.0% for PDT v 3.6% for ST, P = 0.007; displacement, 1.3% for PDT v 4.8% for ST, P = 0.002). Conclusions: In a large heterogeneous group of critically ill patients, single dilator PDT was safe and had few postoperative complications. Although ST was used in higher-risk patients, those who underwent PDT were more likely to receive a larger-sized tracheostomy tube; they were also less likely to experience obstruction or displacement of the postoperative tracheostomy tube. These differences are probably related to a combination of patient selection, smaller, shorter tracheostomy tubes, and larger tissue incision size with ST.</abstract><cop>Australia</cop><pmid>20001871</pmid><doi>10.1016/S1441-2772(23)01282-6</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Care Critical Care Critically ill Female Humans Incidence Intensive care nursing Intensive Care Units Male Medical care Middle Aged Outcome assessment (Medical care) Patient Selection Patients Postoperative Hemorrhage - epidemiology Prospective Studies Surgical Wound Infection - epidemiology Tracheostomy - adverse effects Tracheostomy - methods Tracheostomy - statistics & numerical data Tracheotomy Victoria - epidemiology |
| title | Prospective Observational Study of Postoperative Complications after Percutaneous Dilatational or Surgical Tracheostomy in Critically Ill Patients |
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