气管切开术并发症的种类及发生率

目的： 探讨经皮气管切开术在多发伤救治中的应用价值。 方法： 回顾性分析2012-12-2014-12我院创伤外科行气管切开的多发伤患者128例，将其分为传统气管切开组（传统气切组）和经皮气管切开组（经皮气切组），对比2组患者手术完成情况、易操作性、术中出血量、操作时间、术后并发症发生率、感染菌种构成、机械通气时间、ICU时间、切口愈合时间及住院时间等指标。 结果： 2组患者年龄、性别构成、致伤因素、格拉斯哥昏迷评分（GCS）、伤后切开时间、术后机械通气时间和住院时间比较，差异均无统计学意义（ P >0.05），而经皮气切组患者损伤严重程度评分（ISS）高于传统气切组（ P <0.05）。经皮气切组手术操作时间、术中出血量、切口愈合时间及ICU时间均明显短于（或少于）传统气切组（均 P <0.05）。2组总的术后并发症及感染发生率差异无统计学意义（ P >0.05），而在伤后72 h内行气管切开患者中，经皮气切组并发症发生率低于传统气切组（ P <0.05）。2组总体感染菌种构成差异无统计学意义（ P >0.05）；经皮气切组总的病死率低于传统气切组（ P <0.05），而因肺部感染导致的病死率2组差异无统计学意义（ P >0.05）。 结论： 经皮气管切开术易于培训操作，出血量少，且操作时间短，早期实施并发症少，病死率低，安全性优于传统气管切开术，在多发伤救治中有良好的应用效果。

目的： 比较经皮扩张气管切开术（percutaneous dilational tracheostomy，PDT）与常规气管切开术（surgical tracheostomy，ST）在急危重患者的应用效果和并发症，评价PDT的临床价值。 方法： 选择2012-01-2014-04我院需气管切开的ICU患者，随机分成2组（PDT组与ST组），比较2组患者手术时间、切口长度、术中最低血氧饱和度、术中和术后3 d出血以及术后7 d切口感染的情况。 结果： 234例患者纳入研究并全部顺利完成手术。PDT组和ST组在平均手术时间、切口长度、术中最低血氧饱和度以及术中、术后出血情况方面差异无统计学意义。术后7 d切口感染情况比较，PDT组轻度、中度及重度感染发生率为13.1%（16/122）、4.9%（6/122）、0.8%（1/122），ST组分别20.5%（23/112）、9.8%（11/112）、2.7%（3/112），差异有统计学意义（ P <0.05）。 结论： 与ST比较，PDT具有手术时间短、手术切口小及术后感染风险小等优点，但在术中、术后出血差异无统计学意义。PDF操作简单、快捷、高效，适合于抢救困难插管而又需紧急开放气道的急危重症患者。

目的： 通过分析大宗病例研究经皮旋转扩张气管切开术（PDT）的安全性。 方法： 回顾性分析1 200例行PDT和326例行传统的气管切开术（TT）患者的临床资料，统计分析术后并发症情况。进行PDT和TT两组随机对照试验，每组80例，统计手术中情况（包括手术时间、术中出血量和切口大小）以及术后并发症情况，采用SPSS 17.0软件进行数据分析。 结果： ①随机对照研究：2组患者术中出血量、切口大小和手术时间比较差异均有统计学意义；术后出血例数和并发症总数比较差异均有统计学意义（均 P P >0.05）。②大样本研究：术后出血、术后感染、皮下气肿及并发症总数差异均有统计学意义（均 P P >0.05）。 结论： 本研究通过大样本和随机对照研究进一步验证PDT是一种快速建立长久人工气道的安全方法，符合现代微创的手术发展方向。PDT不仅手术操作时间短，技术易于掌握，而且安全可靠。对于需行气管切开术的危重症患者，如无明显手术禁忌证，可以首先选择PDT，在熟练掌握了其操作技巧后，成功率和安全性都很高。

目的：探讨纤维支气管镜引导下经皮扩张气管切开术在口腔颌面外科的应用价值。方法：选择因手术需要行预防性气管切开的口腔颌面外科患者60例，随机分为3组（n=20）: 经典手术气管切开组（A组）、经皮扩张气管切开组（B组）、纤维支气管镜引导下经皮扩张气管切开组（C组）。观察并记录3组的气管切开操作时间、出血量、一次性置管成功率、血氧饱和度（SpO2 ）变化和并发症的差异。采用SPSS 17.0软件包对数据进行统计学分析。结果：与经典手术A组相比，B组和C组在气管切开中的操作时间显著缩短，出血量和并发症减少，一次性置管成功率显著提高（P＜0.05）。与B组相比，C组在操作时间上显著减少，一次性置管成功率显著提高（P＜0.05）。结论：纤维支气管镜引导下经皮扩张气管切开术安全有效，在口腔颌面外科手术中有较高的应用价值。

目的 评价神经外科患者无支气管镜辅助行经皮扩张气管切开术的可行性和安全性. 方法 2002年～2006年182例神经外科患者于首都医科大学附属北京天坛医院ICU行经皮气管切开术.使用导丝扩张钳(GWDF)技术(152例)和经皮旋转扩张(Percutwist)技术(30例).所有患者均未使用支气管镜辅助.记录手术一般情况及并发症,随访3个月.比较国内外相关资料的差别. 结果 所有患者均置管成功.GWDF方法操作时间平均约4～5min,Percutwist方法操作时间平均约8.5min,其中熟练者操作约6～7min,欠熟练者操作约10min.并发症发生率为4.95%,常见并发症为切口出血(6例)及切口感染(2例).发现1例皮下气肿.研究期间未见气胸、气管食管瘘和有症状的气管狭窄等,无与气管切开相关的死亡. 结论 神经外科患者无支气管镜辅助行经皮扩张气管切开术安全可行,但必须严格掌握适应证并严格进行人员技术培训,认真操作.有条件时应使用支气管镜辅助以进一步降低并发症的发生.

目的 探讨经超声定位引导的经皮扩张气管切开术的安全性及有效性。 方法 选取2015-01～2016-01在冀中能源峰峰集团总医院重症医学科（ICU）治疗且行经皮扩张气管切开术的50例患者，按随机数字分组的方法，将患者随机分为超声定位引导经皮扩张气管切开术（USPDT）组及解剖定位经皮扩张气管切开术（ALPDT）组，记录入选患者的年龄、性别、身高、体质量、入组时的急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)及序贯器官功能障碍评分（SOFA评分）；同时记录手术时间、1次穿刺成功率、穿刺次数、术中出血量及手术并发症。 结果 50例患者纳入研究，无排除病例。USPDT组患者的1针穿刺成功率(92% vs. 64%）高、穿刺次数［（1.08±0.28）次 vs.（1.56±0.87）次］少、术中出血量［（5.48±4.43）mL vs.（11.20±8.41）mL］及手术时间［（7.12±2.42）min vs.（12.20±5.80）min］少于ALPDT组，差异有统计学意义(P≤0.05)；两组患者低氧血症、皮下气肿、气管食管瘘、假道、术后出血发生率比较差异无统计学意义(P>0.05)。 结论 超声定位引导明显提高1次穿刺成功率和穿刺准确性，减少术中出血量。超声引导的经皮气管切开术值得临床推广应用。

To describe the incidence of tracheostomy‐related complications and identify prognostic risk factors.

… identified an overall incidence of tracheal stenosis of … incidence is similar to that identified by vanHearn et al 17 and Walz et al. The present study is unique in that all 422 tracheostomies …

… intermediate and late complications present. It … complications related to tracheotomy. Most retrospective studies have assessed the incidence of significant complications of tracheotomy …

Introduction Tracheostomy is a procedure that can be associated with several well-described complications in the literature, which can be divided into transoperative, early postoperative and late postoperative. When performed in children, these risks are more common than in adults. Objective To perform a systematic review of complications, including deaths, in tracheostomized pediatric patients. Methods A search was carried out for articles in the Latin American and Caribbean Health Sciences Literature and PubMed databases. Cohort studies and series reports were selected, in addition to systematic reviews, published between January 1978 and June 2020, with patients up to 18 years old, and written in English, Spanish or Portuguese. Results 1560 articles were found, of which 49 were included in this review. The average complication rate was 40%, which showed an association with age, birth weight, prematurity, comorbidities, and emergency procedures. The most common complications were cutaneous lesions and granulomas. Mortality related to the procedure reached up to 6% in children and was mainly related to cannula obstruction or accidental decannulation. Conclusion Pediatric tracheostomy is associated with several complications. The tracheostomy-related mortality rate is low, but the overall mortality of tracheostomized patients is not negligible.

To investigate patterns of tracheostomy‐associated death in the United States.

… Data regarding tracheotomy tube complications from consecutive surgeries performed … to identify the incidence of surgical complications following tracheotomy and associated RFs. …

Objectives To investigate national and regional variations in pediatric tracheostomy rates, epidemiology, and outcomes from 2000 to 2012. Study Design Retrospective cohort analysis. Setting Previous research with the 1997 edition of the Kids’ Inpatient Database (KID), a national database of pediatric hospital discharge data, demonstrated that rates and outcomes of pediatric tracheostomy vary among US geographic regions. The KID has since been released an additional 5 times, increasing in size with successive editions. Subjects and Methods Patients ≤18 years old with procedure codes for permanent or temporary tracheostomy from 2000 to 2012 were included. Primary outcome was a weighted population-based rate of tracheostomy stratified by year. Secondary analysis included epidemiologic characteristics and outcomes stratified by year and geographic region. Results A weighted total of 24,354 cases was analyzed. Population-based tracheostomy rates decreased from 6.8 ± 0.2 (mean ± SD) tracheostomies per 100,000 child-years in 2000 to 6.0 ± 0.2 in 2012. Minorities increased from 53.3% in 2000 to 56.4% in 2012. Patients experienced increased procedures, diagnoses, length of stay, and hospital charges with time. From 2000 to 2012, rates and outcomes varied by US geographic region. Mortality during hospitalization (8%) did not vary by year, patient age, region, or sex. Conclusions Pediatric tracheostomy is associated with variation in incidence, epidemiology, and hospitalization outcomes in the United States from 2000 to 2012. While rates of pediatric tracheostomy decreased, patients became increasingly medically complicated and ethnically diverse with outcomes varying according to geographic region.

… tracheotomy at our institution is associated with an overall 19.9% incidence of complications… However, our study does show a significant incidence of complications: the institutional data …

… for elective tracheostomy, there is little late complication data. This study compared incidence of, and factors contributing to, tracheal stenosis following PT or open tracheostomy (OT). …

Background: Tracheostomy is a procedure commonly conducted in patients undergoing emergency admission and requires prolonged mechanical ventilation. In the present study, the aim was to determine the prevalence and risk factors of mortality among emergently admitted patients with tracheostomy complications, during the years 2005–2014. Methods: This was a retrospective cohort study. Demographics and clinical data were obtained from the National Inpatient Sample, 2005–2014, to evaluate elderly (65+ years) and non-elderly adult patients (18–64 years) with tracheostomy complications (ICD-9 code, 519) who underwent emergency admission. A multivariable logistic regression model with backward elimination was used to identify the association between predictors and in-hospital mortality. Results: A total of 4711 non-elderly and 3315 elderly patients were included. Females included 44.5% of the non-elderly patients and 47.6% of the elderly patients. In total, 181 (3.8%) non-elderly patients died, of which 48.1% were female, and 163 (4.9%) elderly patients died, of which 48.5% were female. The mean (SD) age of the non-elderly patients was 50 years and for elderly patients was 74 years. The mean age at the time of death of non-elderly patients was 53 years and for elderly patients was 75 years. The odds ratio (95% confidence interval, p-value) of some of the pertinent risk factors for mortality showed by the final regression model were older age (OR = 1.007, 95% CI: 1.001–1.013, p < 0.02), longer hospital length of stay (OR = 1.008, 95% CI: 1.001–1.016, p < 0.18), cardiac disease (OR = 3.21, 95% CI: 2.48–4.15, p < 0.001), and liver disease (OR = 2.61, 95% CI: 1.73–3.93, p < 0.001). Conclusion: Age, hospital length of stay, and several comorbidities have been shown to be significant risk factors in in-hospital mortality in patients admitted emergently with the primary diagnosis of tracheostomy complications. Each year of age increased the risk of mortality by 0.7% and each additional day in the hospital increased it by 0.8%.

… The purpose of this study was to assess the incidence of late complications in our unit. … the incidence of late tracheostomy complications and to compare this to the complications arising …

… the incidence of complications and dysphagia in relation to the timing of tracheostomy and tracheostomy … Eighteen patients received a percutaneous dilatational tracheostomy (PDT) and …

Tracheostomy, whether open or percutaneous, is a commonly performed procedure and is intended to provide long-term surgical airway for patients who are dependent on mechanical ventilatory support or require (for various reasons) an alternative airway conduit. Due to its invasive and physiologically critical nature, tracheostomy placement can be associated with significant morbidity and even mortality. This article provides a comprehensive overview of commonly encountered complications that may occur during and after the tracheal airway placement, including both short- and long-term postoperative morbidity.

OBJECTIVE The number of tracheostomies performed annually in resource-rich countries is estimated at 250,000. While an essential procedure, approximately 20% to 30% of patients will experience at least 1 tracheostomy-related adverse event. Within tracheostomy care and across wider health care environments, quality improvement (QI) programs have been shown to reduce patient harm and improve outcomes. Herein we report on a 5-year long, tracheostomy QI initiative aimed at improving patient experience and reducing the frequency and severity of adverse events. METHODS A 5-year (ongoing) QI initiative led by the Cardiff and Vale University Health Board tracheostomy team, within a tertiary, 1000-bedded hospital in South Wales, United Kingdom. The QI initiative has focused on 3 main themes: (1) Education and training; (2) Clinical oversight and decision making; and (3) improved data collection. Data were collected from existing tracheostomy databases. RESULTS Over the past 5 years, we have observed a sustained reduction in both the frequency and severity of adverse events, with less than 1 patient per 100 experiencing a moderate or severe adverse event. This has resulted in improvements in patient experience and a cost reduction of £GBP364,726 per annum. DISCUSSION Our 5-year ongoing tracheostomy QI initiative has resulted in improved outcomes with increased achievement of tracheostomy weaning markers and sustained reductions in both the frequency and severity of adverse events. IMPLICATIONS FOR PRACTICE A continuous focus on QI is associated with improved patient and service outcomes. These improvements can be spread and scaled to benefit more patients and organizations.

OBJECTIVE Tracheotomy is one of the most common procedures. Although tracheostomy complications have been extensively studied, literature related to device complications is scarce. The objective of this study is to describe complications associated with tracheostomies utilizing the Manufacturer and User Facility Device Experience (MAUDE) database. STUDY DESIGN Retrospective cross-sectional study. SETTING The US Food and Drug Administration's (FDA) MAUDE database (2015-2020). METHODS The FDA's MAUDE database was queried for all reports on adverse events related to tracheostomy from January 1, 2015 to December 31, 2020. RESULTS A total of 3086 adverse events related to open tracheostomy and 52 related to percutaneous tracheostomy were identified. For open tracheostomy, 2872 (93%), were related to device malfunction, and 214 (7%) consisted of patient-related factors. The most frequently reported device-related adverse event was cuff malfunction, with 1834 (59%) reported events, which includes cuff deflation, pilot balloon malfunction, and cuff inflation line malfunction. The most frequently reported patient-related adverse events were tracheostomy tube obstruction with 67 events (2%). For percutaneous tracheostomy, 38 (73%) events were related to device malfunction, and 14 (27%) were related to patient injury. The most frequently reported adverse events were cuff malfunction (29%), safety ridge malfunction (17%), and bleeding (10%). CONCLUSION The MAUDE database is a useful tool that can be utilized to complement existing literature in identifying common and rare adverse events associated with tracheostomy device-related failures, which are mostly reliant on isolated, published case reports.

… late tracheostomy is associated with beneficial outcome or reduced rates of adverse events. … of early tracheostomy versus late tracheostomy on outcome variables and the occurence of …

… variation in the rates of tracheostomy in trauma patients with … underwent tracheostomy, the mean tracheostomy rate across … a direct result of those initial adverse events, so I think that …

… , closed-loop system for monitoring tracheostomy-related adverse events. Initial results of … delivered by reducing the rates of preventable tracheostomy-related events. Careful tracking …

We evaluated the association between the timing of tracheostomy and clinical outcomes in patients with infratentorial lesions. We performed a retrospective observational cohort study in a neurosurgical intensive care unit (ICU) at a tertiary academic medical center from January 2014 to December 2018. Consecutive adult patients admitted to the ICU who underwent resection of infratentorial lesions as well as tracheostomy were included for analysis. Early tracheostomy was defined as performed on postoperative days 1–10 and late tracheostomy on days 10–20 after operation. Univariate and multivariate analyses were used to compare the characteristics and outcomes between both cohorts. A total of 143 patients were identified, and 96 patients received early tracheostomy. Multivariable analysis identified early tracheostomy as an independent variable associated with lower occurrence of pneumonia (odds ratio, 0.25; 95% CI, 0.09–0.73; p  = 0.011), shorter stays in ICUs (hazard ratio, 0.4; 95% CI, 0.3–0.6; p  = 0.03), and earlier decannulation (hazard ratio, 0.5; 95% CI, 0.4–0.8; p  = 0.003). However, no significant differences were observed between the early and late tracheostomy groups regarding hospital mortality ( p  > 0.999) and the modified Rankin scale after 6 months ( p  = 0.543). We also identified postoperative brainstem deficits, including cough, swallowing attempts, and extended tongue as well as GCS < 8 at ICU admission as the risk factors independently associated with patients underwent tracheostomy. There is a significant association between early tracheostomy and beneficial clinical outcomes or reduced adverse event occurrence in patients with infratentorial lesions.

BACKGROUND Advances in medical care and ventilator technologies increase the number of children with tracheostomy and home mechanical ventilation (HMV). Data on severe adverse events in home care and in specialized nursing care facilities are limited. PATIENTS AND METHODS Retrospective analysis of incidence and type of severe adverse events in children with tracheostomy and HMV in home care compared to a specialized nursing care facility over a 7-year period. RESULTS 163.9 patient-years in 70 children (home care: 110.7 patient-years, 24 patients; nursing care facility: 53.2 patient-years, 46 patients) were analyzed. In 34 (48.6%) patients tracheostomy was initiated at the age of <1 year. 35 severe adverse events were identified, incidence of severe adverse events per patient-year was 0.21 (median 0.0 (0.0-3.0)). We observed no difference in the rate of severe adverse events between home care and specialized nursing care facility (0.21 [y-1]; median 0.0 (0.0-3.0) versus 0.23 [y-1]; median 0.0 (0.0-1.6); p = 0.690), however, significantly more tracheostomy related incidents and infections occurred in the home care setting. Young age (<1 year) (Odds ratio 3.27; p = 0.045) and feeding difficulties (nasogastric tubes and percutaneous endoscopic gastrostomy) (Odds ratio 9.08; p = 0.016) significantly increased the risk of severe adverse events. Furthermore, the rate of severe adverse events was significantly higher in patients with a higher nursing score. CONCLUSION Pediatric home mechanical ventilation via tracheostomy is rarely associated with emergencies or adverse events in home care as well as in a specialized nursing care facility setting.

AIM(S) To systematically locate, evaluate and synthesize evidence regarding effectiveness of interprofessional tracheostomy teams in increasing speaking valve use and decreasing time to speech and decannulation, adverse events, lengths of stay (intensive care unit (ICU) and hospital) and mortality. In addition, to evaluate facilitators and barriers to implementing an interprofessional tracheostomy team in hospital settings. DESIGN Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Johns Hopkins Nursing Evidence-Based Practice Model's guidance. METHODS Our clinical question: Do interprofessional tracheostomy teams increase speaking valve use and decrease time to speech and decannulation, adverse events, lengths of stay and mortality? Primary studies involving adult patients with a tracheostomy were included. Eligible studies were systematically reviewed by two reviewers and verified by another two reviewers. DATA SOURCES MEDLINE, CINAHL and EMBASE. RESULTS Fourteen studies met eligibility criteria; primarily pre-post intervention cohort studies. Percent increase in speaking valve use ranged 14%-275%; percent reduction in median days to speech ranged 33%-73% and median days to decannulation ranged 26%-32%; percent reduction in rate of adverse events ranged 32%-88%; percent reduction in median hospital length of stay days ranged 18-40 days; no significant change in overall ICU length of stay and mortality rates. Facilitators include team education, coverage, rounds, standardization, communication, lead personnel and automation, patient tracking; barrier is financial. CONCLUSION Patients with tracheostomy who received care from a dedicated interprofessional team showed improvements in several clinical outcomes. IMPLICATIONS FOR PATIENT CARE Additional high-quality evidence from rigorous, well-controlled and adequately powered studies are necessary, as are implementation strategies to promote broader adoption of interprofessional tracheostomy team strategies. Interprofessional tracheostomy teams are associated with improved safety and quality of care. IMPACT Evidence from review provides rationale for broader implementation of interprofessional tracheostomy teams. REPORTING METHOD PRISMA and Synthesis Without Meta-analysis (SWiM). PATIENT/PUBLIC CONTRIBUTION None.

Adults have an increased risk of tracheostomy complications as body mass increases. A similar association has not been established in pediatric patients. This study assesses the relationship between weight‐for‐length percentile or body mass index (BMI) and adverse tracheostomy events in infants and children, respectively.

… At our institution, percutaneous dilational tracheostomy without routine bronchoscopy … tracheostomy experience would demonstrate that the technique is safe with low complication rates, …

… Tracheostomy-related adverse event rates varied … tracheostomy, which have reported an overall mortality rate of 7%.… < 1 year) at the time of tracheostomy placement, children of Hispanic …

OBJECTIVES To elucidate the impact of early tracheostomy on hospitalization outcomes in patients with traumatic brain injury. DATA SOURCES Lilacs, PubMed, and Cochrane databases were searched. The close-out date was August 8, 2018. STUDY SELECTION Studies written in English, French, Spanish, or Portuguese with traumatic brain injury as the base trauma, clearly formulated question, patient's admission assessment, minimum follow-up during hospital stay, and minimum of two in-hospital outcomes were selected. Retrospective studies, prospective analyses, and case series were included. Studies without full reports or abstract, commentaries, editorials, and reviews were excluded. DATA EXTRACTION The study design, year, patient's demographics, mean time between admission and tracheostomy, neurologic assessment at admission, confirmed ventilator-assisted pneumonia, median ICU stay, median hospital stay, mortality rates, and ICU and hospital costs were extracted. DATA SYNTHESIS A total of 4,219 studies were retrieved and screened. Eight studies were selected for the systematic review; of these, seven were eligible for the meta-analysis. Comparative analyses were performed between the early tracheostomy and late tracheostomy groups. Mean time for early tracheostomy and late tracheostomy procedures was 5.59 days (SD, 0.34 d) and 11.8 days (SD, 0.81 d), respectively. Meta-analysis revealed that early tracheostomy was associated with shorter mechanical ventilation duration (-4.15 [95% CI, -6.30 to -1.99]) as well as ICU (-5.87 d [95% CI, -8.74 to -3.00 d]) and hospital (-6.68 d [95% CI, -8.03 to -5.32 d]) stay durations when compared with late tracheostomy. Early tracheostomy presented less risk difference for ventilator-associated pneumonia (risk difference, 0.78; 95% CI, 0.70-0.88). No statistical difference in mortality was found between the groups. CONCLUSIONS The findings from this meta-analysis suggest that early tracheostomy in severe traumatic brain injury patients contributes to a lower exposure to secondary insults and nosocomial adverse events, increasing the opportunity of patient's early rehabilitation and discharge.

Objective To describe the Trach Safe Initiative and assess its impact on unanticipated tracheostomy-related mortality in outpatient tracheostomy-dependent children (TDC). Methods An interdisciplinary team including parents and providers designed the initiative with quality improvement methods. Three practice changes were prioritized: (1) surveillance airway endoscopy prior to hospital discharge from tracheostomy placement, (2) education for community-based nurses on TDC-focused emergency airway management, and (3) routine assessment of airway events for TDC in clinic. The primary outcome was annual unanticipated mortality after hospital discharge from tracheostomy placement before and after the initiative. Results In the 5 years before and after the initiative, 131 children and 155 children underwent tracheostomy placement, respectively. At the end of the study period, the institution sustained Trach Safe practices: (1) surveillance bronchoscopies increased from 104 to 429 bronchoscopies, (2) the course trained 209 community-based nurses, and (3) the survey was used in 488 home ventilator clinic visits to identify near-miss airway events. Prior to the initiative, 9 deaths were unanticipated. After Trach Safe implementation, 1 death was unanticipated. Control chart analysis demonstrates significant special-cause variation in reduced unanticipated mortality. Discussion We describe a system shift in reduced unanticipated mortality for TDC through 3 major practice changes of the Trach Safe Initiative. Implication for Practice Death in a child with a tracheostomy tube at home may represent modifiable tracheostomy-related airway events. Using Trach Safe practices, we address multiple facets to improve safety of TDC out of the hospital.

… Inadequate preparation for adverse events can potentially … While it is accepted that bedside percutaneous tracheostomy … tracheostomy, we saw a significant decrease in the rate of …

… The duration of mechanical ventilation, length of stay (LOS) in intensive care unit (ICU), incidence of pneumonia, adverse event rate, unnecessary tracheostomy and outcomes were …

… Tracheostomy is one of the most frequently performed procedures in intensive care … approaches are open surgical tracheostomy (ST) and percutaneous dilatational tracheostomy (PDT). …

Tracheostomy continues to be a standard procedure for the management of long-term ventilator-dependent patients. Traditionally the procedure has been performed by surgeons in the operating theater using an open technique. This routine practice has recently been challenged by the introduction of bedside percutaneous dilatational tracheostomy (PDT), which has been reported to be a cost-effective alternative. The purpose of this study is to evaluate and compare the safety, procedure time, cost, and utilization of percutaneous and surgical tracheostomies at a university hospital. A retrospective medical chart review was performed on all ventilator-dependent intensive care unit patients at the University of Virginia Medical Center undergoing tracheostomy during a 23-month period beginning December 26, 1996. Of the 213 patients identified for review, 74 and 139 patients received percutaneous and surgical tracheostomies, respectively. Of 74 percutaneous tracheostomies, 73 reviewed were performed by general surgeons, pulmonary physicians, or anesthesiologists in the intensive care unit; all open tracheostomies were performed by surgeons in the operating room, and one percutaneous procedure was performed in the operating room. Perioperative complications occurred in five of 74 patients (6.76%) during PDT; of these, three patients (4.1%) experienced major complications requiring emergent operative exploration of the neck. Three patients (2.2%) experienced perioperative complications during surgical tracheostomy. The mean procedure time was significantly shorter for the percutaneous procedure. Average charges per patient in an uncomplicated case including professional fees, inventory, bronchoscopy (if performed), and operating room charges were $1753.01 and $2604.00 for percutaneous and standard tracheostomies, respectively. These charges do not include the charges associated with surgical intervention after PDT complications. In contrast to previously published reports showing complications clustered during a physician's first 30 percutaneous cases, our study demonstrated no relationship between complication occurrence and physician experience. That is, no learning curve associated with performing PDT was evident. In addition there was no association seen between physician specialty and complication rate. PDT in the intensive care unit costs less than surgical tracheostomy performed in the operating room and can be performed in less time. Several other studies have recommended that bronchoscopy during PDT provides additional safety; however, in our series all three major complications took place during bronchoscopy-assisted percutaneous procedures. Our series suggests that PDT carries an appreciable risk of major complications. Careful patient selection and additional experience with the procedure may decrease complication rates to an acceptable level.

… Complications … to surgical tracheostomies, percutaneous tracheostomies were rapidly and easily performed at the bedside and were associated with significantly fewer complications. …

… Despite many studies comparing surgical tracheostomy (ST) versus PDT, there remains no consensus on which of these techniques minimizes complications in critically ill patients. …

… of tracheostomies. The relatively high rate of complications may be due to the strict definitions used and the fact that we were looking intensively for complications. This led to including …

Context: The operative technique for surgical tracheostomy has remained unchanged, but different techniques for percutaneous tracheostomy have evolved due to interest in minimally invasive procedures for the critically ill patient. Aims: To compare the periprocedural complications and long term outcomes of bedside surgical tracheostomy (ST) with two percutaneous tracheostomy (PCT) techniques, namely serial guide wire dilating forceps (GWDF) and PercuTwist (PT). Settings and Design: This prospective observational study was carried out in ICU of a tertiary referral centre over three year period on adult intubated patients needing elective tracheostomy. Materials and Methods: Patients with anticipated difficult neck anatomy were assigned for ST based on discretion of intensivist. Patients included for PCT were randomly assigned to the GWDT and PT technique. 90 patients underwent either bedside ST (n = 30), PCT by GWDF technique (n = 30) or PCT with PercuTwist (n = 30) and were followed up with fibreoptic bronchoscopy monthly for 06 months. Statistical Analysis Used: Data was analyzed by applying chi square tests for categorical variables. Results: Periprocedural complications during PCT included major bleeding (>100ml) in two patients in GWDF group which required conversion to ST. Periprocedural bleeding was also the main complication in ST. Increased incidence of granulation tissue and tracheal narrowing in long term was seen in both ST and PCT groups. All of the P values analysed for the intra operative, post operative complications or long term outcomes were >0.05. Conclusions: There was no statistically significant difference in incidence of complications of ST and two techniques of PCT. Proper case selection makes PCT as safe as ST.

… complications between surgical tracheotomy (ST) and percutaneous dilational tracheotomy (… Studies to the right of the y-axis demonstrate a higher rate of complications for PDT. Grand …

… surgical intervention occurred in three percutaneous tracheostomy patients and in no surgical tracheostomy … the ICU and there have been no deaths due to tracheostomy complications. …

Background: Tracheostomy facilitates respiratory care and the process of weaning from mechanical ventilatory support. Aims: To compare the complications found in percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) techniques. Methods: This was a prospective randomized study to evaluate the complications of PDT and ST procedures in patients admitted to ICU unit of a teaching hospital during 2008 to 2011. We studied 40 patients in each group. PDTs were performed with blue rhino technique at the bedside by a skilled clinician and all cases of STs performed by Charles G Durbin technique in operating room under general anesthesia. Bronchoscopic examination through tracheostomy tube was performed to ensure the correct position of tracheostomy tube in the trachea lumen. The duration of procedures and pre- and post-interventional complications were recorded. Results: The most common complications observed in the PDT group were minor bleeding (n=4), hypoxemia, and cardiac dysrhythmias (n=3) whereas in the ST group, the most frequent complications were minor bleeding (n=5) and endotracheal tube puncture (n=3). The difference in overall complications between the two groups was insignificant (P=0.12). Conclusion: PDT with blue rhino technique is a safe, quick, and effective method while the overall complications in both groups were comparable.

The purpose of this study was to compare timing of procedure, patient characteristics, outcomes, and charges for patients who underwent percutaneous versus surgical tracheostomy.

… complications in 1684 percutaneous tracheostomy patients … The current patient cost for standard surgical tracheostomy in … minutes); a percutaneous tracheostomy performed in the same …

… , unlike in surgical tracheostomy, PDT does not require the patient to be transported to the operating room; 23 moreover, the common practice of bedside surgical tracheostomy in the …

… ) and percutaneous techniques (opening of the trachea with … to surgical tracheostomies, percutaneous tracheostomies … the number of complications associated with tracheostomy. These …

BackgroundTracheostomy is one of the most frequently performed procedures in intensive care medicine. The two main approaches to form a tracheostoma are the open surgical tracheotomy (ST) and the interventional strategy of percutaneous dilatational tracheotomy (PDT). It is particularly important to the critically ill patients that both procedures are performed with high success rates and low complication frequencies. Therefore, the aim of this systematic review is to summarize and analyze existing and relevant evidence for peri- and postoperative parameters of safety.Methods/designA systematic literature search will be conducted in The Cochrane Library, MEDLINE, LILACS, and Embase to identify all randomized controlled trials (RCTs) comparing peri- and postoperative complications between the two strategies and to define the strategy with the lower risk of potentially life-threatening events. A priori defined data will be extracted from included studies, and methodological quality will be assessed according to the recommendations of the Cochrane Collaboration.DiscussionThe findings of this systematic review with proportional meta-analysis will help to identify the strategy with the lowest frequency of potentially life-threatening events. This may influence daily practice, and the data may be implemented in treatment guidelines or serve as the basis for planning further randomized controlled trials. Considering the critical health of these patients, they will particularly benefit from evidence-based treatment.Systematic review registrationPROSPERO CRD42015021967

… of complications, so we decided to follow authors' individual definitions of complications rank … However, PDT techniques resulted much cheaper than surgical tracheostomy. Finally, …

OBJECTIVE To assess and describe postoperative complications of single dilator percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) in a large series of critically ill patients. METHODS A prospective observational study was conducted in 1163 critically ill patients in a university affiliated tertiary referral hospital between 2002 and 2007. PDT was the procedure of choice for all critically ill patients requiring tracheostomy except for those with an anatomic abnormality or refractory coagulopathy, who underwent ST. Demographic and postoperative complication data were collected in a web-based database. RESULTS 913 patients (79%) underwent PDT at the bedside in the ICU, and 250 (21%) underwent ST in the operating theatre. The tracheostomy tube was larger, and the duration of tracheostomy cannulation was shorter after PDT than after ST. The postoperative complication rate for PDT was 9.6% compared with 19.6% for ST (P<0.001). Tracheal tube obstruction and displacement were significantly less frequent after PDT (obstruction 1.0% for PDT v 3.6% for ST, P = 0.007; displacement, 1.3% for PDT v 4.8% for ST, P = 0.002). CONCLUSIONS In a large heterogeneous group of critically ill patients, single dilator PDT was safe and had few postoperative complications. Although ST was used in higher-risk patients, those who underwent PDT were more likely to receive a larger-sized tracheostomy tube; they were also less likely to experience obstruction or displacement of the postoperative tracheostomy tube. These differences are probably related to a combination of patient selection, smaller, shorter tracheostomy tubes, and larger tissue incision size with ST.

… a low incidence of complications. The aim of this study was to compare the costs, complications, and time consumption of PDT with that of conventional surgical tracheostomy (ST) when …

IntroductionThe aim of this study was to conduct a meta-analysis to determine whether percutaneous tracheostomy (PT) techniques are advantageous over surgical tracheostomy (ST), and if one PT technique is superior to the others.MethodsComputerized databases (1966 to 2013) were searched for randomized controlled trials (RCTs) reporting complications as predefined endpoints and comparing PT and ST and among the different PT techniques in mechanically ventilated adult critically ill patients. Odds ratios (OR) and mean differences (MD) with 95% confidence interval (CI), and I2 values were estimated.ResultsFourteen RCTs tested PT techniques versus ST in 973 patients. PT techniques were performed faster (MD, −13.06 minutes (95% CI, −19.37 to −6.76 (P <0.0001)); I2 = 97% (P <0.00001)) and reduced odds for stoma inflammation (OR, 0.38 (95% CI, 0.19 to 0.76 (P = 0.006)); I2 = 2% (P = 0.36)), and infection (OR, 0.22 (95% CI, 0.11 to 0.41 (P <0.00001)); I2 = 0% (P = 0.54)), but increased odds for procedural technical difficulties (OR, 4.58 (95% CI, 2.21 to 9.47 (P <0.0001)); I2 = 0% (P = 0.63)). PT techniques reduced odds for postprocedural major bleeding (OR, 0.39 (95% CI, 0.15 to 0.97 (P = 0.04)); I2 = 0% (P = 0.69)), but not when a single RCT using translaryngeal tracheostomy was excluded (OR, 0.58 (95% CI, 0.21 to 1.63 (P = 0.30)); I2 = 0% (P = 0.89)). Eight RCTs compared different PT techniques in 700 patients. Multiple (MDT) and single step (SSDT) dilatator techniques are associated with the lowest odds for difficult dilatation or cannula insertion (OR, 0.30 (95% CI, 0.12 to 0.80 (P = 0.02)); I2 = 56% (P = 0.03)) and major intraprocedural bleeding (OR, 0.29 (95% CI, 0.10 to 0.85 (P = 0.02)); I2 = 0% (P = 0.72)), compared to the guide wire dilatation forceps technique.ConclusionIn critically ill adult patients, PT techniques can be performed faster and reduce stoma inflammation and infection but are associated with increased technical difficulties when compared to ST. Among PT techniques, MDT and SSDT were associated with the lowest intraprocedural risks and seem to be preferable.

… in the tracheostomy-related complications of subglottic stenosis… early as 7 days after laryngeal intubation,6 it is possible that intubation, rather than ET, is the cause of these complications…

… difference between the early and late tracheostomy groups, … found a significant decrease in the early tracheostomy group. … of late complications was found in either the early or late …

… endotracheal intubation warrant early tracheotomy.Obviously, … earlier article in this issue. We feel, however, that a properly performed tracheotomy has a low incidence of complications …

Tracheostomy may be associated with numerous acute, perioperative complications, some of which continue to be relevant well after the placement of the tracheostomy. A number of clinically important unique late complications have been recognized as well, including the formation of granulation tissue, tracheal stenosis, tracheomalacia, tracheoinnominate-artery fistula, tracheoesophageal fistula, ventilator-associated pneumonia, and aspiration. The clinical relevance of these complications is considerable, as their manifestations range from minimally symptomatic to failure to wean from the ventilator (tracheal stenosis) to life-threatening hemorrhage (tracheoinnominate fistula). Treatment modalities vary depending upon the nature of the complication. For the most frequent complication, tracheal stenosis, a multidisciplinary approach utilizing bronchoscopy, laser, airway stents, and tracheal surgery is most effective.

As the coronavirus disease 2019 (COVID‐19) pandemic spread worldwide in 2020, the number of patients requiring intensive care and invasive mechanical ventilation (IMV) has increased rapidly. During the pandemic, early recommendations suggested that tracheostomy should be postponed, as the potential benefits were not certain to exceed the risk of viral transmission to healthcare workers. The aim of this study was to assess the utility of tracheostomy in patients with COVID‐19‐related acute respiratory distress syndrome, in terms of patient and clinical characteristics, outcomes, and complications, by comparing between early and late tracheostomy.

Complications from surgical procedures are common and must be taken into account when assessing the risks and benefits of a particular treatment approach. Common acute risks of tracheostomy include bleeding, airway loss, damage to adjacent structures, and failure of the chosen technique to achieve successful airway placement. The frequency and severity of these occurrences depends on several factors. These include the specific approach to tracheostomy, the skill and experience of the operator, and patient anatomic and physiologic factors. The incidence of undesired outcomes during tracheostomy cannot be exactly predicted because of the interaction of the above issues. This paper will consider some of the common and less common acute complications of several of the usual techniques for temporary tracheostomy placement in critically ill patient.

Objectives: The aim of this study is to present our experience with elective surgical tracheostomy for intensive care unit (ICU) patients who needed prolonged translaryngeal intubation in order to evaluate the proper timing and advantages of early vs. late tracheostomy and to stress upon the risks associated with delayed tracheostomy. Methods: Medical records of all patients, who underwent elective tracheostomy for prolonged intubation from September 2006 to August 2010 at Jordan University hospital, were reviewed. Results: A total of 106 patients (74 males) were included; their age ranged from 2 months to 90 yr with mean age of 46.5 yr. The mean time at which tracheostomy was done after initial tracheal intubation was 23 days (range 3-7 weeks). Trauma was the most frequent cause of ICU admission 38 (35.8%), followed by post-surgery causes 14 (13.2%). An early tracheostomy showed less complication vs late procedure. The length of stay in the ICU for patients who had an early tracheostomy was 26 days while this period for patients who had late tracheostomy was 47 days. Mortality rate among patients who had early tracheostomy was 17.1% while for late tracheostomy patients, it was 36.1%. Conclusion: Proper assessment and early tracheostomy is recommended for patients who require prolonged tracheal intubation in the ICU.

… , we found no severe complications with tracheostomy in this … rate of complications associated with tracheostomy would be … reports that showed a low tracheostomy-related mortality rate …

BACKGROUND: The timing of tracheostomy in ventilated patients remains controversial. This study aimed to compare the effect of early tracheostomy (≤7 d) with late tracheostomy (>7 d) on the prognosis of patients requiring prolonged mechanical ventilation. METHODS: This was a retrospective observational cohort study. The data of 175 patients who received tracheostomy at the ICU between January 1, 2015–July 31, 2022, were collected. Patients were excluded from the study if medical records were incomplete or they underwent tracheostomy as part of a planned operation procedure. One-to-one propensity score matching was used to correct the baseline characteristics between the early and late tracheostomy groups. The treatment process and outcomes were compared between the two groups. The primary outcome was the incidence of ventilator-associated pneumonia (VAP) between groups. RESULTS: After propensity score matching, 88 subjects were included in the analysis. Compared with the late tracheostomy group, the incidence of VAP, hospital length of stay, sedation-free days, ventilator-free days, and ICU-free days were longer in the early tracheostomy group. There were no significant differences in the 90-d mortality between the two groups. CONCLUSIONS: Early tracheostomy can reduce the occurrence of complications for ICU patients.

Introduction. Tracheostomy can help weaning in long-term ventilated patients, reducing the duration of mechanical ventilation and intensive care unit length of stay, and decreasing complications from prolonged tracheal intubation. In traumatic brain injury (TBI), ideal timing for tracheostomy is still debated. We performed a systematic review and meta-analysis to evaluate the effects of timing (early vs. late) of tracheostomy on mortality and incidence of VAP in traumatic brain-injured patients. Methods. This study was conducted in conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We performed a search in PubMed, using an association between heading terms: early, tracheostomy, TBI, prognosis, recovery, impact, mortality, morbidity, and brain trauma OR brain injury. Two reviewers independently assessed the methodological quality of eligible studies using the Newcastle–Ottawa Scale (NOS). Comparative analyses were made among Early Tracheostomy (ET) and late tracheostomy (LT) groups. Our primary outcome was the odds ratio of mortality and incidence of VAP between the ET and LT groups in acute brain injury patients. Secondary outcomes included the standardized mean difference (MD) of the duration of mechanical ventilation, ICU length of stay (LOS), and hospital LOS. Results. We included two randomized controlled trials, three observational trials, one cross-sectional study, and three retrospective cohort studies. The total number of participants in the ET group was 2509, while in the LT group it was 2597. Early tracheostomy reduced risk for incidence of pneumonia, ICU length of stay, hospital length of stay and duration of mechanical ventilation, but not mortality. Conclusions. In TBI patients, early tracheostomy compared with late tracheostomy might reduce risk for VAP, ICU and hospital LOS, and duration of mechanical ventilation, but increase the risk of mortality.

OBJECTIVES: To compare the clinical outcomes of early versus late tracheostomy in patients who require prolonged mechanical ventilation. METHODS: A prospective observational study was done. The sample was a cohort of 90 patients who had tracheostomy in the medical intensive care unit of a university-affiliated teaching hospital. Primary outcome measures were duration of mechanical ventilation and total cost of hospitalization. Tracheostomy was defined as early if performed by day 10 of mechanical ventilation and late if performed thereafter. RESULTS: Fifty-three patients had early tracheostomy (mean +/- SD = day 5.9 +/- 7.2 of ventilation), and 37 patients had late tracheostomy (mean +/- SD = day 16.7 +/- 2.9) (P &amp;lt; .001). The mean (+/- SD) duration of mechanical ventilation was 28.3 +/- 28.2 days in the early-tracheostomy group versus 34.4 +/- 17.8 days in the late-tracheostomy group (P = .005). Total cost of hospitalization was significantly lower in the early-tracheostomy group (mean +/- SD = $86,189 +/- $53,570) than in the late-tracheostomy group (mean +/- SD = $124,649 +/- $54,282) (P = .001). Male sex (adjusted odds ratio = 3.84; 95% CI = 2.32-6.34; P = .007) and higher ratios of PaO2 to fraction of inspired oxygen (adjusted odds ratio = 1.01; 95% CI = 1.00-1.01; P = .03) were associated with early tracheostomy. The timing of tracheostomy was not associated with hospital mortality. CONCLUSION: Early tracheostomy is associated with shorter lengths of stay and lower hospital costs than is late tracheostomy among patients in the medical intensive care unit. Prospective clinical trials are necessary to determine the optimal timing of tracheostomy in that setting.

OBJECTIVE: The optimal timing of tracheostomy in nonneurologically injured mechanically ventilated critically ill adult patients is uncertain. We conducted a systematic review of randomized controlled trials to evaluate the effect of early versus late tracheostomy or prolonged intubation in this population. DATA SOURCES: We searched MEDLINE, Embase, CENTRAL, CINAHL, and Web of science databases for randomized controlled trials comparing early tracheostomy (<10 d of intubation) with late tracheostomy or prolonged intubation in adults. DATA SELECTION: We selected trials comparing early tracheostomy (defined as being performed less than 10 d after intubation) with late tracheostomy (performed on or after the 10th day of intubation) or prolonged intubation and no tracheostomy in nonneurologically injured patients. The primary outcome was overall mortality. Secondary outcomes included ventilator-associated pneumonia, duration of mechanical ventilation, ICU, and hospital length of stay. DATA EXTRACTION: Two reviewers screened citations, extracted data, assessed the risk of bias, and classification of Grading of Recommendations, Assessment, Development, and Evaluation independently. DATA SYNTHESIS: Our search strategy yielded 8,275 citations, from which nine trials (n = 2,457) were included. We did not observe an effect on the overall mortality of early tracheostomy compared with late tracheostomy or prolonged intubation (risk ratio, 0.91, 95% CI, 0.82–1.01; I2 = 18%). Our results were consistent in all subgroup analyses. No differences were observed in ICU and hospital length of stay, duration of mechanical ventilation, incidence of ventilator-acquired pneumonia, and complications. Our trial sequential analysis showed that our primary analysis on mortality was likely underpowered. CONCLUSION: In our systematic review, we observed that early tracheostomy, as compared with late tracheostomy or prolonged intubation, was not associated with a reduction in overall mortality. However, we cannot exclude a clinically relevant reduction in mortality considering the level of certainty of the evidence. A well-designed trial is needed to answer this important clinical question.

… trials comparing early tracheostomy to late tracheostomy or … complications (epiglottis, vocal cords, larynx, or subglottic ulceration and inflammation, or tracheostomy complications), and …

… Tracheostomy is a life-saving tool readily available to modern physicians. This review describes tracheostomy complications in … them arbitrarily into early and late complications. The …

Objective For critically ill patients undergoing long-term mechanical ventilation, to determine whether early conversion from endotracheal intubation to tracheostomy reduces the incidence of laryngotracheal stenosis. Data Sources MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature. Review Methods A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and an assessment of bias were performed. Included studies reported outcomes of patients who were converted from endotracheal intubation to tracheostomy, compared early vs late tracheostomy, and reported the incidence of laryngotracheal stenosis and details of postoperative surveillance. Data were also collected for intensive care setting, method of tracheostomy, and timing of tracheostomy. Results Seven articles met inclusion criteria: 2 randomized trials, 2 quasi-randomized trials, 1 prospective cohort, and 2 retrospective cohorts. A total of 966 patients were included in this analysis (496 in the early tracheostomy group and 470 in the late tracheostomy group). The mean incidence of laryngotracheal stenosis was 8.9% (range, 0%-20.8%), with a mean incidence of 8.1% in early tracheostomy groups and 10.9% in late tracheostomy groups. In studies with the least risk of bias, there were no differences in the incidence of laryngotracheal stenosis in patients who underwent early vs late tracheostomy. Conclusion In critically ill patients undergoing long-term mechanical ventilation, early conversion to tracheostomy within 7 days of intubation does not significantly decrease the risk of laryngotracheal stenosis compared to later conversion as defined by the included studies.

… The whole findings of this systematic review are no more than suggestive of the superiority of early over late tracheostomy because no information of high quality is available for specific …

Objective: To explore the characteristics, reasons for complications and prevention measurement of tracheotomy in children. Method: The clinical data of 136 cases of tracheotomy from 1986 to 2001 were retrospectively analyzed. Results: Complications happened in 19 cases, including bleeding in 6 cases, emphysema in 6 cases, asphyxia during the operations in 2 cases, esophagus injuries in 2 cases, and drops of the tubes during the operations in 3 cases. The frequency was 26.67% in children below 3 years. The frequency was 26.8% for emergent tracheotomy and 26.47% for tracheotomy with a local anaesthesia. Conclusion: Complications in tracheotomy in children are closely related to the age, operative occasion, operative method and nursing.

Objective To compare the clinical performance of percutaneous dilational tracheostomy(PDT) without the assistance of bronchoscopy and surgical tracheostomy(ST). Methods 60 patients were divided into the PDT group and the control group (ST group) and all the operations were performed in the ICU. Differences between the PDT and ST group were investigated, including operation time, size of incision, blood loss, incidence of pneumothorax and subcutaneous emphysema, tracheal esophageal fistula and symtomatic tracheal stenosis , wound infection, healing time, and changes of vital signs in the operation. Results Compared with the control, PDT was more convenient and could significantly reduce the operation time and operative complications. Conclusion Under strict indications, percutaneous dilational tracheostomy can be widely applied in the clinic. Unlike traditional tracheostomy, it is simpler and safer with shorter operative time, less trauma, and fewer complications.