Pathologic changes of the trachea after percutaneous dilatational tracheotomy.

The tracheas of 12 patients who had undergone autopsies after percutaneous dilatational tracheotomy (PDT) were analyzed macroscopically and microscopically. The puncture site of the trachea varied from just below the cricoid cartilage (two patients) to below the third ring (three patients). A fracture of one or more tracheal rings was present in 11 patients, of whom 2 had a fractured cricoid. Destruction of one or more tracheal rings was present in all eight patients cannulated for more than 10 days and was related to duration of cannulation (p<0.005). Protrusion of the anterior wall into the tracheal lumen with tracheal stenosis was seen in two patients. Improvements to the PDT technique are discussed to avoid complications.