Tracheal lesion caused by percutaneous dilatational tracheostomy - a clinico-pathological study

Objective: To analyse the accuracy of cannula placement and the extent of tracheal lesions of the anterior tracheal wall after percutaneous dilatational tracheostomy (PDT). Design: A clinico-pathological study of tracheal specimens following PDT. Setting: University hospital. Materials: Forty-two tracheal specimens of intensive care patients (24 male, 18 female; age: 23-70 years) who died unrelated to tracheostomy. Interventions: Using tracheoscopic guidance, PDTs were performed by Ciaglia's method. Tracheal cannulas with outer diameters of 11-12 mm were used. The duration of cannulation ranged from 1 to 97 days (median: 10.5 days). Results: PDTs were placed between the 1st and 4th tracheal rings in 32 cases, above the first ring in 7 cases and below the 4th in 3 cases. Twenty specimens showed a horizontal intercartilaginous rupture of the anterior tracheal wall, 12 tracheas additionally had fractures of tracheal rings and in 10 specimens defects of tracheal cartilage (range: 15 mm(2)-120 mm(2)) were found. The occurrence of tracheal defects was influenced by the height of puncture (p < 0.05) and duration of cannulation (p < 0.01). Conclusion: Misplacement of the tracheal cannula above or below the intended tracheal area occurred in one-fourth of our patients. The typical tracheal lesion following PDT is transverse rupture of the anterior tracheal wall with or without fracture of neighbouring rings. Extended cartilaginous defects are rare, which may explain the low rate of tracheal stenosis following PDT.