Tracheal stenosis following percutaneous dilatational tracheostomy using the single tapered dilator: an MRI study

• Published in: Anaesthesia and intensive care Vol. 42; no. 6; pp. 745 - 751
• Main Authors: Young, E, Pugh, R, Hanlon, R, O'Callaghan, E, Wright, C, Jeanrenaud, P, Jones, T M
• Format: Journal Article
• Language: English
• Published: United States Sage Publications Ltd 01.11.2014
• Subjects: Adult; Aged; Cohort Studies; Dilatation - adverse effects; Dilatation - instrumentation; Dilatation - methods; Female; Humans; Magnetic Resonance Imaging - methods; Male; Middle Aged; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Prospective Studies; Spirometry - methods; Spirometry - statistics & numerical data; Surveys and Questionnaires; Trachea - pathology; Tracheal Stenosis - diagnosis; Tracheal Stenosis - etiology; Tracheostomy - adverse effects; Tracheostomy - instrumentation; Tracheostomy - methods; critical care; dilatational; complications; percutaneous; tracheostomy
• ISSN: 0310-057X; 1448-0271
• DOI: 10.1177/0310057x1404200610

Despite widespread adoption of percutaneous dilatational tracheostomy within the critical care setting, there is still uncertainty regarding long-term complications, particularly in relation to missed or subclinical tracheal stenosis. In this study, all patients underwent tracheostomy using a single tapered dilator ≥ three months prior to enrollment and were evaluated using magnetic resonance imaging, spirometry and questionnaire. Tracheal area was recorded and deemed to be stenotic if a reduction of ≥10% was found. Fifty patients underwent magnetic resonance imaging and 49 attended for interview. Five patients were diagnosed with tracheal stenosis-none were symptomatic. Six of the 50 tracheostomies were technically difficult. Spirometry was not predictive of stenosis. A post critical care exercise tolerance of less than 100 metres was found in four tracheal stenosis patients. The prevalence of subclinical tracheal stenosis following percutaneous tracheostomy is low, with limited clinical significance. No patients required corrective surgery for tracheal stenosis. Routine airway follow-up in asymptomatic patients appears to be unwarranted.