Late complications of percutaneous dilatational tracheotomy.

STUDY OBJECTIVE

To assess the late complications of percutaneous dilatational tracheotomy, particularly the incidence of tracheal stenosis and voice changes.

DESIGN

Prospective descriptive clinical study.

SETTING

Teaching hospital, the Netherlands.

PATIENTS

Eighty consecutive patients who were successfully decannulated after percutaneous tracheotomy.

MEASUREMENTS AND RESULTS

Fourteen patients died after decannulation, of tracheotomy-unrelated causes. Sixty-six patients were followed up 3 to 39 months after decannulation (mean, 16 months). Fifty-four patients underwent tomography of the trachea. In 14 patients (26%), there was tracheal narrowing of more than 10%. Data analysis showed that these stenoses were operator dependent (p = 0.03). Voice changes, found in 13 (21%) of 61 patients, were major in 1 and minor in 12. Scars were generally cosmetically acceptable. Retraction of the scar, seen in 13 (19%) of 66 patients, was related to the duration of cannulation (p = 0.002). A persistent tracheocutaneous fistula was present in two patients.

CONCLUSIONS

The incidence of tracheal stenosis after percutaneous dilatational tracheotomy is low compared with conventional tracheotomy. Experience with the technique is important to avoid late complications.