Safety of percutaneous dilatational tracheostomy with direct bronchoscopic guidance for solid organ allograft recipients

E. Andrew Waller, Javier F. Aduen, David J. Kramer, Francisco Alvarez, Michael G. Heckman, Julia E. Crook, Octavio E. Pajaro, Lawrence R. McBride, Cesar A. Keller

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

OBJECTIVE: To determine the safety of percutaneous dilatational tracheostomy (PDT) for solid organ allograft recipients, who have increased risks of bleeding and infection. PATIENTS AND METHODS: We reviewed the records of patients who underwent solid organ transplant between January 1, 2001, and September 30, 2005, followed by PDT (using the Ciaglia technique) with direct bronchoscopic guidance. We recorded comorbid conditions, number of days from intubation and transplant, positive end-expiratory pressures, ratios of Pao 2 to fraction of inspired oxygen, coagulation study findings, complications, and procedure-related mortality rates. RESULTS: Of the 51 patients in our study, 17 had undergone lung transplant; 32, liver transplant; and 2, kidney transplant. The median age was 55 years (range, 27-73), and 53% of patients were men. The median time from intubation to PDT was 10 days and from transplant to PDT, 22 days. The median ratio of Pao2 to fraction of inspired oxygen was 293, and the median positive end-expiratory pressure was 5 cm H2O. Twenty-one patients were receiving dialysis, and 11 were recovering from sepsis (of these, 8 were receiving vasopressors). Ten had coagulopathies (none of which were associated with bleeding complications). Complications were infrequent (7 periprocedural, 4 postprocedural) and included bleeding, bradycardia, hypotension, tracheal ring fracture, and cannula malfunction. Of the bleeding complications, only 2 were clinically remarkable and required removal of the tracheostomy or surgical revision. No infectious complications or procedure-related deaths were noted. CONCLUSION: Percutaneous dilatational tracheostomy was tolerated well in recipients of solid organ allografts and had a relatively low risk of major complications and a low procedure-related mortality rate. This method should be considered an acceptable alternative to surgical tracheostomy.

Original languageEnglish (US)
Pages (from-to)1502-1508
Number of pages7
JournalMayo Clinic proceedings
Volume82
Issue number12
DOIs
StatePublished - Dec 2007

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'Safety of percutaneous dilatational tracheostomy with direct bronchoscopic guidance for solid organ allograft recipients'. Together they form a unique fingerprint.

  • Cite this

    Andrew Waller, E., Aduen, J. F., Kramer, D. J., Alvarez, F., Heckman, M. G., Crook, J. E., Pajaro, O. E., McBride, L. R., & Keller, C. A. (2007). Safety of percutaneous dilatational tracheostomy with direct bronchoscopic guidance for solid organ allograft recipients. Mayo Clinic proceedings, 82(12), 1502-1508. https://doi.org/10.4065/82.12.1502