Percutaneous tracheostomy--long-term outlook, a review.

OBJECTIVE To review the techniques and long term complications of the various techniques of percutaneous tracheostomy in the critically ill patient. DATA SOURCES A review of studies reported on the various percutaneous tracheostomy techniques. SUMMARY OF REVIEW A tracheostomy is frequently performed in the critically ill patient when prolonged mechanical ventilation, airway protection and pulmonary toilet are required. It is also facilitates weaning from mechanical ventilation, reduces laryngeal injury and improves patient comfort thus decreasing the need for sedation. The percutaneous dilatational technique can be easily and rapidly performed at the bedside. Short-term complication rates associated with percutaneous tracheostomies range between 7-22% and include bleeding, pneumothorax, subcutaneous emphysema, paratracheal insertion, posterior tracheal wall laceration, damage to or insertion through the endotracheal tube, hypoxia, hypotension and arrhythmias, cuff leak, endotracheal tube obstruction, loss of airway, premature extubation and wound infection. Peri-operative mortality ranges from 0.2 to 0.7%. The incidence of these complications often depends on the experience of the operator. Long-term complications and their incidence are not as well defined. CONCLUSIONS In the critically ill patient who requires a tracheostomy, the percutaneous tracheostomy has become the method of choice as it can be performed at the bedside, leaves a smaller scar after decannulation and may be associated with fewer complications compared with the standard surgical technique.