Surgical Tracheotomies Present Risk for Fatal Complications

The most common causes of tracheotomy-related deaths are hemorrhage, loss of airway, and false passage, according to a new study.

Researchers at Municipal Hospital Dresden (Germany) evaluated data on open surgical tracheotomy (OCT) as well as on percutaneous dilational tracheotomy (PCT). Of the 25,056 tracheotomies described, there were 16,827 PDTs and 7,934 OSTs; for 295 tracheotomies, the technique used was not stated. In total, 352 deaths were reported. The death rate was similar for both procedures, with the most common causes of death being hemorrhage, loss of airway, and misplacement of the tube into a false passage.

The researchers also included recommendations to reduce the risk during tracheotomy surgery. These include avoiding tracheotomies below the level of the 4th tracheal ring, due to the vascular anatomy in the area, and using rigid tracheobronchoscopy in cases of severe hemorrhage because of the good visibility and high suction capacity for blood offered by this method. In addition, they recommend that tracheotomies should not be performed by inexperienced surgeons. The study was published in the April 2017 issue of Deutsches Ärzteblatt International.

“Tracheotomies are among the most common procedures in ventilated patients in intensive care. In the United States alone, an estimated 500 patients die every year or experience long-term impairments as a result of a tracheotomy,” concluded study co-author Professor Andreas Nowak, MD, of the department of anesthesiology and intensive care medicine, and colleagues. “Careful training under instruction by experienced physicians and using the World Health Organization’s surgical safety checklist may help prevent tracheotomy-associated deaths.”

Tracheotomy is a surgical procedure, which consists of an incision on the anterior aspect of the neck and the opening of a direct airway through the incision into the trachea. The resulting stoma can serve independently as an airway, or as a site for a tracheal or tracheostomy tube to be inserted, allowing a person to breathe without the use of the nose or mouth. Indications for chronic tracheotomy include long-term mechanical ventilation and tracheal toilet. In the acute care setting, indications include such severe facial trauma, tumors of the head and neck, and acute angioedema and inflammation of the head and neck.

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Municipal Hospital Dresden