Late complications of percutaneous dilatational tracheotomy

Study objective: To assess the late complications of percutaneous dilatational tracheotomy, particularly the incidence of tracheal stenosis and voice changes. Design: Prospective descriptive clinical study. Setting: Teaching hospital, the Netherlands. Patients: Eighty consecutive patients who were successfully decannulated after percutaneous tracheotomy. Measurements and results: Fourteen patients died after decannulation, of tracheotomy-unrelated causes. Sixty-six patients were followed up 3 to 39 months after decannulation (mean, 16 months). Fifty-four patients underwent tomography of the trachea. In 14 patients (26%), there was tracheal narrowing of more than 10%. Data analysis showed that these stenoses were operator dependent (p=0.03). Voice changes, found in 13 (21%) of 61 patients, were major in 1 and minor in 12. Scars were generally cosmetically acceptable. Retraction of the scar, seen in 13 (19%) of 66 patients, was related to the duration of cannulation (p=0.002). A persistent tracheocutaneous fistula was present in two patients. Conclusions: The incidence of tracheal stenosis after percutaneous dilatational tracheotomy is low compared with conventional tracheotomy. Experience with the technique is important to avoid late complications.