Current Status and Problems of Tracheostomy in Our Hospital

Abstract

Percutaneous dilational tracheostomy (PDT) is commonly performed in intensive care units due to its shorter operation time and simpler surgical procedure than surgical tracheostomy (ST). We retrospectively assessed the surgical complications in patients who received a tracheostomy in our tertiary hospital between April 2016 and March 2018. In a total of 182 patients, PDT was performed in 25 cases and ST in 157 cases, in which the most common reason for tracheostomy was difficulty of extubation. The postoperative complications were wound infection in 12 cases, tube obstruction in 8 cases, prolonged bleeding in the wound bed in 6 cases, difficulty of incubation tube replacement in 4 cases, and granuloma in the airway in 5 cases. As for complications of PDT, we experienced 2 cases with severe surgical complications after PDT. One case suffered prolonged postoperative bleeding from the wound bed due to the granuloma around the trachea. The other case had severe damage at the anterior wall of the cricoid cartilage after cannula insertion. PDT in our hospital tends to be performed by the main department. In the 2 cases with severe complications after PDT we experienced, the first puncture site might not be appropriate. Therefore, ST is thought to be much safer in cases where cricoid cartilage and thyroid cartilage are difficult to identify from the body surface. Moreover, in order to perform the tracheostomy in safety, we recommend use of bronchoscopes or ultrasound during the procedure.