Implementation of percutaneous dilatational tracheostomy on neurosurgical coma patients

Objective To present the authors' experience with percutaneous dilatational tracheostomy (PDT), with special attention to early and late complications, outcomes, and primary disease influence Methods Between November 2000 and May 2001, 22 PDTs were performed with the aid of dilatating forceps in 21 neurosurgical coma patients A Seldinger wire was introduced through a cannula into the trachea serving as a guide The guidewire was threaded through the clamped guidewire dilating forceps and the forceps was advanced through the tracheal wall The trachea was dilated by opening forceps The guidewire was then threaded through the obturator of the tracheostomy tube and both were advanced into the trachea Demographic data, patient disease variables and patient anatomical features, as well as perioperative and late complications were recorded prospectively Results Completion of the procedure consumed 4-16 minutes (mean, 12 minutes) The procedure caused complications in 3 operations: 2 cases of stomal bleeding, 1 of intratracheal bleeding, but there was no severe tracheal injury or mediastinal emphysema Furthermore, none of the cases required intervention due to complications All patients were followed up for 1 to 6 months Tracheostomy tubes were removed in 16 patients All cervical incisions were closed with cosmetic demand Two patients with tracheostomy tubes were retained for primary diseases Causes of death in 3 others were unrelated to the PDT No patient developed tracheomalacia or tracheal stenosis as a late complication Conclusions Percutaneous dilatational tracheostomy is a fast, safe and simple procedure for neurosurgical coma patients and can be safely performed by neurosurgeons