Percutaneous tracheostomy, experience with the SIMS® kit

Joseph L. Nates, Denise Marx, Christine S Cocanour, Frederick A. Moore

Research output: Contribution to journalArticle

Abstract

Intoduction: Percutaneous dilational tracheostomy (PDT) is considered a more advantageous procedure compared to the classic open surgical approach. However, remarkable differences may exist among the different PDT techniques available. Methods: A retrospective review of PDTs performed with the SIMS® kit during the period between January 1997 and March 1998 was undertaken. A previously formatted questionnaire was completed in each case. The questions included: Gender, age, diagnosis, complications and discharge status. Complications considered were: Intraoperative loss of airway, paratracheal intubation, esophageal injury, tracheal rings fracture, loss of tracheal tube after fixation, bleeding requiring transfusion, bronchoscopy or exploration, airway obstruction, pneumothorax, infection, intracranial hypertension during procedure, arrhythmia and death associated with the procedure. Results: Only 66 files from the 83 selected contained enough information to be surveyed. Among them, there were 40 males, mean age 50. The operations were performed on average 12 days after injury and 3 days after posted. Surgery residents under direct supervision of 5 different attendings (Procedure Team) conducted the operations. We found 15 complications among 5 (7.5%) patients. These included: Intraoperative loss of airway (1), fracture of tracheal rings requiring surgical repair in the operating room (1), major bleeding (3), clot related airway obstruction (2) and due to tube characteristics (1), intracranial hypertension during procedure (1), tension pneumothorax (1), arrhythmia (1), arrest (2) and death (2). Thirty-three per cent of the complications were intraoperative and 66.6% ocurred between the first 24 hours and 7 days following the procedure. The 2 patients that died were males, mean age 46. The first died as result of an obstruction of the beveled endotracheal tracheostomy tube of the kit against the trachea causing a bilateral tension pneumothorax and arrest. The second patient died as result of an obstruction caused by active bleed 4 days after the procedure, leading to hypoxemia, ventricular fibrillation and arrest. Conclusions: We found an unexpectedly high morbidity (22.7%) and mortality (3%) using the PDT technique with the SIMS® kit. The complications can be attributed to a learning curve of the members of the Procedure Team. However, the special characteristics of the tracheostomy kit used (beveled endotracheal tube, no Murphy's eye, straight dilators) are of concern. In fact, these differences may have been the cause of at least one of the deaths in this survey.

Original languageEnglish (US)
JournalCritical Care Medicine
Volume27
Issue number1 SUPPL.
StatePublished - 1999
Externally publishedYes

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Tracheostomy
Pneumothorax
Intracranial Hypertension
Airway Obstruction
Cardiac Arrhythmias
Hemorrhage
Learning Curve
Intraoperative Complications
Wounds and Injuries
Bronchoscopy
Ventricular Fibrillation
Operating Rooms
Trachea
Intubation
Morbidity
Mortality

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Nates, J. L., Marx, D., Cocanour, C. S., & Moore, F. A. (1999). Percutaneous tracheostomy, experience with the SIMS® kit. Critical Care Medicine, 27(1 SUPPL.).

Percutaneous tracheostomy, experience with the SIMS® kit. / Nates, Joseph L.; Marx, Denise; Cocanour, Christine S; Moore, Frederick A.

In: Critical Care Medicine, Vol. 27, No. 1 SUPPL., 1999.

Research output: Contribution to journalArticle

Nates, JL, Marx, D, Cocanour, CS & Moore, FA 1999, 'Percutaneous tracheostomy, experience with the SIMS® kit', Critical Care Medicine, vol. 27, no. 1 SUPPL..
Nates, Joseph L. ; Marx, Denise ; Cocanour, Christine S ; Moore, Frederick A. / Percutaneous tracheostomy, experience with the SIMS® kit. In: Critical Care Medicine. 1999 ; Vol. 27, No. 1 SUPPL.
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abstract = "Intoduction: Percutaneous dilational tracheostomy (PDT) is considered a more advantageous procedure compared to the classic open surgical approach. However, remarkable differences may exist among the different PDT techniques available. Methods: A retrospective review of PDTs performed with the SIMS{\circledR} kit during the period between January 1997 and March 1998 was undertaken. A previously formatted questionnaire was completed in each case. The questions included: Gender, age, diagnosis, complications and discharge status. Complications considered were: Intraoperative loss of airway, paratracheal intubation, esophageal injury, tracheal rings fracture, loss of tracheal tube after fixation, bleeding requiring transfusion, bronchoscopy or exploration, airway obstruction, pneumothorax, infection, intracranial hypertension during procedure, arrhythmia and death associated with the procedure. Results: Only 66 files from the 83 selected contained enough information to be surveyed. Among them, there were 40 males, mean age 50. The operations were performed on average 12 days after injury and 3 days after posted. Surgery residents under direct supervision of 5 different attendings (Procedure Team) conducted the operations. We found 15 complications among 5 (7.5{\%}) patients. These included: Intraoperative loss of airway (1), fracture of tracheal rings requiring surgical repair in the operating room (1), major bleeding (3), clot related airway obstruction (2) and due to tube characteristics (1), intracranial hypertension during procedure (1), tension pneumothorax (1), arrhythmia (1), arrest (2) and death (2). Thirty-three per cent of the complications were intraoperative and 66.6{\%} ocurred between the first 24 hours and 7 days following the procedure. The 2 patients that died were males, mean age 46. The first died as result of an obstruction of the beveled endotracheal tracheostomy tube of the kit against the trachea causing a bilateral tension pneumothorax and arrest. The second patient died as result of an obstruction caused by active bleed 4 days after the procedure, leading to hypoxemia, ventricular fibrillation and arrest. Conclusions: We found an unexpectedly high morbidity (22.7{\%}) and mortality (3{\%}) using the PDT technique with the SIMS{\circledR} kit. The complications can be attributed to a learning curve of the members of the Procedure Team. However, the special characteristics of the tracheostomy kit used (beveled endotracheal tube, no Murphy's eye, straight dilators) are of concern. In fact, these differences may have been the cause of at least one of the deaths in this survey.",
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AU - Moore, Frederick A.

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N2 - Intoduction: Percutaneous dilational tracheostomy (PDT) is considered a more advantageous procedure compared to the classic open surgical approach. However, remarkable differences may exist among the different PDT techniques available. Methods: A retrospective review of PDTs performed with the SIMS® kit during the period between January 1997 and March 1998 was undertaken. A previously formatted questionnaire was completed in each case. The questions included: Gender, age, diagnosis, complications and discharge status. Complications considered were: Intraoperative loss of airway, paratracheal intubation, esophageal injury, tracheal rings fracture, loss of tracheal tube after fixation, bleeding requiring transfusion, bronchoscopy or exploration, airway obstruction, pneumothorax, infection, intracranial hypertension during procedure, arrhythmia and death associated with the procedure. Results: Only 66 files from the 83 selected contained enough information to be surveyed. Among them, there were 40 males, mean age 50. The operations were performed on average 12 days after injury and 3 days after posted. Surgery residents under direct supervision of 5 different attendings (Procedure Team) conducted the operations. We found 15 complications among 5 (7.5%) patients. These included: Intraoperative loss of airway (1), fracture of tracheal rings requiring surgical repair in the operating room (1), major bleeding (3), clot related airway obstruction (2) and due to tube characteristics (1), intracranial hypertension during procedure (1), tension pneumothorax (1), arrhythmia (1), arrest (2) and death (2). Thirty-three per cent of the complications were intraoperative and 66.6% ocurred between the first 24 hours and 7 days following the procedure. The 2 patients that died were males, mean age 46. The first died as result of an obstruction of the beveled endotracheal tracheostomy tube of the kit against the trachea causing a bilateral tension pneumothorax and arrest. The second patient died as result of an obstruction caused by active bleed 4 days after the procedure, leading to hypoxemia, ventricular fibrillation and arrest. Conclusions: We found an unexpectedly high morbidity (22.7%) and mortality (3%) using the PDT technique with the SIMS® kit. The complications can be attributed to a learning curve of the members of the Procedure Team. However, the special characteristics of the tracheostomy kit used (beveled endotracheal tube, no Murphy's eye, straight dilators) are of concern. In fact, these differences may have been the cause of at least one of the deaths in this survey.

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