抄録
Percutaneous dilational tracheostomy (PDT) has become an appropriate alternative to conventional surgical tracheostomy and has gained worldwide acceptance. Multiple publications in recent years have reported the efficacy and relative safety of this approach. However, PDT is not always feasible or practicable, and problems can occur. With the more widespread use of PDT, the uncommon but serious complications of pneumothoraces and mediastinal emphysema resulting from posterior tracheal wall perforation are more often seen. A 16-year-old female suffering from head injury underwent PDT. On the morning after surgery, the patient developed subcutaneous emphysema, decreased arterial saturation, and decreased breath sounds in both sides of the chest. Tension pneumothoraces and mediastinal emphysema associated with PDT were documented radiographically. Thoracostomy tubes were inserted, followed by immediate clinical improvement. Iatrogenic posterior tracheal wall perforation is a complication of PDT, not generally associated with open tracheostomy. This serious complication occurs because of technical errors committed during the PDT insertion. The use of concurrent endoluminal visualization to confirm proper needle insertion and placement, avoidance of excessive force, and proper patient selection have been identified as factors vital to performing PDT in a safe and controlled fashion. Concurrent endoluminal visualization by bronchoscopy is essential in reducing the technical complications of PDT insertion.
