Safety and Efficiency of Percutaneous Dilatational Tracheostomy With Direct Bronchoscopic Guidance for Thoracic Transplant Recipients

Respiratory Care
Kevin PilarczykMarkus Kamler

Abstract

Percutaneous dilatational tracheostomy (PDT) is the standard airway access in critically ill patients who require prolonged mechanical ventilation. However, the literature lacks reports about the effectiveness and safety of this procedure in thoracic organ transplant recipients, who have increased risks of bleeding and infection. We retrospectively reviewed the records of subjects who underwent thoracic organ transplantation at our institution between January 2004 and March 2011 followed by PDT (using the Ciaglia Blue Rhino technique with direct bronchoscopic guidance). From a total of 312 thoracic transplant recipients, we identified 93 (29.8%) subjects with PDT. Of these, 79 had undergone double lung transplant, 11 had undergone heart transplant, 2 had undergone combined heart-lung transplant, and 1 had undergone combined heart-kidney transplant. Mean age was 49.5 ± 11.2 y, and 58% of subjects were female. The mean time from intubation to PDT was 3.7 ± 3.4 d, and mean time from transplant to PDT was 12.6 ± 28.3 d. Thirty-two subjects (34.4%) underwent PDT after re-intubation. Thirty-nine subjects were receiving renal replacement therapy (41.9%), and 28 had a coagulopathy (30.1%). Moderate but not significant bleeding was obse...Continue Reading

Citations

Dec 10, 2019·Clinical Transplantation·Stephen J HuddlestonGabriel Loor
May 26, 2018·General Thoracic and Cardiovascular Surgery·Ryo MiyoshiHiroshi Date
Jul 30, 2020·Seminars in Respiratory and Critical Care Medicine·Mark Greer, Tobias Welte

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