The Otolaryngology, Head and Neck Surgery Unit, Ziv Medical Center, Zefat, Israel.
Am J Otolaryngol. 2012 Nov-Dec;33(6):770-3. doi: 10.1016/j.amjoto.2012.07.001. Epub 2012 Aug 22.
Fatal complications of percutaneous dilatational tracheostomy (PDT) are rare and intraoperative fatal complications of PDT even more so. We present the unique case of a fatal nonvascular intraoperative complication of PDT, previously unreported in the medical literature. We also present a review of all previously reported fatal complications of PDT.
A review of all previously reported fatal complications of PDT was conducted in order to examine the prevalent causes of death and to attempt to recommend measures designed to prevent similar fatal complications in the future.
Cases of death during or following PDT in which the technique is related to the cause of death have only been reported in a small number of cases. Almost all fatal complications of PDT result from vascular injury.
Any vascular pulsation palpated over the tracheostomy site mandates preoperative ultrasound or conversion to open surgical tracheostomy. Patients with previous neck surgery, radiotherapy or unclear surgical anatomy should be regarded with caution. If a difficult intubation or a difficult procedure is anticipated, it may be preferable not to attempt PDT with a plan to convert to surgical tracheostomy if necessary but instead to perform surgical tracheostomy without attempting PDT.
经皮扩张气管切开术（PDT）的致命并发症很少见，术中 PDT 的致命并发症更是罕见。我们报告了一例独特的 PDT 术中非血管性致命并发症，该并发症以前在医学文献中没有报道过。我们还回顾了所有先前报道的 PDT 致命并发症。
对所有先前报道的 PDT 致命并发症进行了回顾，以检查常见的死因，并试图提出预防未来类似致命并发症的措施。
只有少数病例报告了 PDT 术中或术后与技术相关的死亡病例。几乎所有 PDT 的致命并发症都是由于血管损伤引起的。
在气管切开部位触诊到任何血管搏动都需要术前超声或转为开放式外科气管切开术。既往颈部手术、放疗或手术解剖不明确的患者应谨慎对待。如果预计会出现困难的插管或困难的操作，最好不要尝试 PDT，如果需要，可以转为外科气管切开术，而不是直接进行 PDT。
