eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Laryngology

Percutaneous Tracheostomy: Follow-up

Author: Scott E Brietzke, MD, MPH, Assistant Professor of Surgery, Uniformed Services University of the Health Sciences; Director, Pediatric Otolaryngology, Department of Surgery, Otolaryngology Service, Walter Reed Army Medical Center; Associate Program Director, National Capital Consortium Residency in Otolaryngology
Coauthor(s): Michael S Kong, MD, Resident Physician, Department of Otolaryngology, National Capital Consortium; Joshua S Schindler, MD, Assistant Professor, Department of Otolaryngology, Oregon Health and Science University; Darius Bliznikas, MD, Staff Physician, Department of Otolaryngology, Wayne State University School of Medicine; Soly Baredes, MD, Associate Professor of Clinical Surgery, Chief, Section of Otolaryngology-Head and Neck Surgery, Director, Division of Head and Neck Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Contributor Information and Disclosures

Updated: Sep 10, 2008

Outcome and Prognosis

Because percutaneous tracheostomy (PCT) is performed in critically ill patients, late outcome of the procedure is difficult to describe. The mortality rate is high, but this high rate related to medical problems other than PCT. Mortality because of PCT or related complications is relatively rare.

Conditions after PCT that significantly affect patients' lives and everyday activities are few. Symptomatic tracheal stenosis, the most difficult long-term complication to manage that requires operative correction, is relatively rare (1.9%). Hoarseness and temporary voice changes were reported by a significant number of patients (with a prevalence of up to 50%). In most cases, however, these changes are related to previous translaryngeal intubation. Direct injuries to the vocal cords or recurrent laryngeal nerve are extremely rare. Small skin incisions and few adjacent anatomical structure injuries due to blunt tissue dissection lead to favorable cosmetic results in stomal wound healing.

Future and Controversies

Percutaneous tracheostomy (PCT) has undergone and continues to undergo rigorous evaluation regarding its safety and the simplicity of its techniques. New percutaneous methods as well as modifications of the currently popular techniques have continued to develop.  As new methods are introduced, future prospective randomized clinical studies would be helpful. PCT has been shown to be a safe and viable alternative to the standard open tracheostomy technique. However, this method has drawbacks and contraindications, and the surgeon performing PCT should be aware of them when making the decision as to which approach to use.

 


More on Percutaneous Tracheostomy

Overview: Percutaneous Tracheostomy
Workup: Percutaneous Tracheostomy
Treatment: Percutaneous Tracheostomy
Follow-up: Percutaneous Tracheostomy
Multimedia: Percutaneous Tracheostomy
References
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Further Reading

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Keywords

percutaneous tracheostomy, tracheostomy, PCT, percutaneous dilational tracheostomy, PDT, guidewire dilating forceps, GWDF, Rapitrach method, mechanical ventilation, airway obstruction, inflammatory disease, benign laryngeal pathology, webs, cysts, papilloma, malignant laryngeal tumors, laryngeal trauma, laryngeal stenosis, tracheal stenosis, pulmonary toilet, obstructive sleep apnea

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Contributor Information and Disclosures

Author

Scott E Brietzke, MD, MPH, Assistant Professor of Surgery, Uniformed Services University of the Health Sciences; Director, Pediatric Otolaryngology, Department of Surgery, Otolaryngology Service, Walter Reed Army Medical Center; Associate Program Director, National Capital Consortium Residency in Otolaryngology
Scott E Brietzke, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, and American Academy of Sleep Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Michael S Kong, MD, Resident Physician, Department of Otolaryngology, National Capital Consortium
Michael S Kong, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physicians, American Medical Association, and Association of Military Surgeons of the US
Disclosure: Nothing to disclose.

Joshua S Schindler, MD, Assistant Professor, Department of Otolaryngology, Oregon Health and Science University
Joshua S Schindler, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Darius Bliznikas, MD, Staff Physician, Department of Otolaryngology, Wayne State University School of Medicine
Darius Bliznikas, MD is a member of the following medical societies: Sigma Xi
Disclosure: Nothing to disclose.

Soly Baredes, MD, Associate Professor of Clinical Surgery, Chief, Section of Otolaryngology-Head and Neck Surgery, Director, Division of Head and Neck Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Soly Baredes, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, American Society for Head and Neck Surgery, New York Academy of Medicine, New York Academy of Sciences, New York Head and Neck Society, North American Skull Base Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society
Disclosure: Nothing to disclose.

Medical Editor

Lanny Garth Close, MD, Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons
Lanny Garth Close, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physicians, American Laryngological Association, American Society for Head and Neck Surgery, and New York Academy of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Gregory C Allen, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Gregory C Allen, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Christian Medical & Dental Society, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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