Routine chest X-rays following bronchoscopy guided percutaneous dilational tracheostomy(PDT)
Date First Published:
March 23, 2007
Last Updated:
March 23, 2007
Report by:
Souvik Das, SHO (Lewisham University Hospital, London, UK)
Search checked by:
Mick Jennings, Lewisham University Hospital, London, UK
Three-Part Question:
In [patients who have undergone bronchoscopy guided percutaneous dilational tracheostomy in intensive care] is a [routine chest x ray necessary] to [rule out immediate postoperative complications like pneumothorax, pneumomediastinum or malposition of tube].
Clinical Scenario:
In the Intensive care unit, a bronchoscopy guided percutaneous dilational tracheostomy (PDT) was performed. There were no clinical signs to suggest immediate post-operative complications like pneumothorax, pneumomediastinum or malposition of tracheostomy tube. You wonder whether a chest X-ray is appropriate to rule out the above mentioned complications.
Search Strategy:
Medline 1966-05/04 using the Ovid interface.
Search Details:
[percutaneous.mp. OR seldinger.mp.] AND [tracheostomy.mp. OR exp tracheostomy/ OR tracheostom$.mp. OR tracheotom$.mp. OR exp tracheotomy/ ] AND [exp postoperative complications/ OR complications.mp.] LIMIT to human.
Outcome:
Altogether three hundred twenty-four (324) papers were found, six (6) of which were relevant to the three part question. These six papers are shown in the table
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Routine chest X-ray after percutaneous tracheostomy is unnecessary. Hoehne F, Ozaeta M, Chung R, et al. 2005, USA | 73 patients underwent bronchoscopy guided PDT. The majority of the tracheostomies were in trauma patients who needed prolonged ventilatory support. | Retrospective chart review | Operative complications detected on CXRs | There were no complications identified on postprocedure chest X-ray. | Retrospective review of chest X-rays in a small patient group |
| The utility, of chest radiographs following percutaneous dilational tracheostomy. Datta D, Onyirimba F, McNamee MJ, et al. 2003, USA | Sixty medicalsurgical ICU patients who underwent PDT under bronchoscopic visualization, for persistent ventilator dependence. |
Retrospective chart review | Operative complications detected on CXRs | In 2 of the 60 patients (3.3%) complications were detected on the post procedure CXRs. One with a pneumomediastinum and the other with a tension pneumothorax. | Retrospective review of chest X-rays in a small patient group. |
| Ciaglia percutaneous dilational tracheostomy. Early and late complications and follow-up. Gambale G, Cancellieri F, Baldini U, Vacchi Suzzi M, Baroncini S, Ferrari F,Petrini F, et al. 2003, Italy | 181 patients admitted between July 1998 and June 2000 who underwent PDT under bronchoscopic guidance, for mechanical ventilation. |
Prospective collection of data | Postoperative pneumothorax or pneumomediastinum or malposition of tube. | No patient had postoperative pneumothorax, pneumomediastinum or malposition of tube. | Small number of patient group. |
| Percutaneous dilatational tracheostomy in the ICU: optimal organization, low complication rates, and description of a new complication. Polderman KH, Spijkstra JJ, de Bree R, Christiaans HM, Gelissen HP, Wester JP, Girbes AR, et al. 2003, Netherlands | 174 critically ill patients in the ICU who underwent bronchoscopic guided PDT. |
Prospective study | Postoperative pneumothorax or pneumomediastinum or malposition of tube. | No patient had postoperative pneumothorax, pneumomediastinum or malposition of tube. | Small number of patients group |
| Complications of bronchoscopically guided percutaneous dilational tracheostomy: beyond the learning curve. Beiderlinden M, Karl Walz M, Sander A, Groeben H, Peters J, et al. 2002, Germany | 136 bronchoscopy guided PDT were performed on mechanically ventilated patients in ICU. |
Prospective study | Postoperative pneumothorax or pneumomediastinum or malposition of tube. | No patient had postoperative pneumothorax, pneumomediastinum or malposition of tube. | Small number of patients group |
| Perioperative complications of percutaneous dilational tracheostomy. Berrouschot J, Oeken J, Steiniger L, Schneider D, et al. 1977, Germany | 76 patients underwent PDT. In 41 patients, PDT was performed "blind." In 35 patients it was executed with simultaneous bronchoscopic monitoring. |
Prospective study | The type and rate of complications of the two groups were compared. It looked into the incidence of complications in these two groups. | One death due to tension pneumothorax in the group where PDT was performed "blind." No incidence of pneumothorax/ pneumomediastinum/malposition of tube, where PDT was under bronchoscopic guidance. | Small number of patients group |
Author Commentary:
The study of Hoehne F et al and Datta D et al are retrospective, so the evidence base is limited. Although all these 6 studies are based on small number of patient groups, it is apparent that all these studies unanimously agree on the following point. There is no benefit in doing routine chest-rays to rule-out immediate postoperative complications like pneumothorax, pneumomediastinum and malposition of tube, following bronchoscopy guided PDT.
Bottom Line:
At present there is no clinical evidence to support routine post-procedure chest X-ray following bronchoscopy guided percutaneous dilational tracheostomy (PDT). But larger study is required to answer this clinical query.
References:
- Hoehne F, Ozaeta M, Chung R, et al.. Routine chest X-ray after percutaneous tracheostomy is unnecessary.
- Datta D, Onyirimba F, McNamee MJ, et al.. The utility, of chest radiographs following percutaneous dilational tracheostomy.
- Gambale G, Cancellieri F, Baldini U, Vacchi Suzzi M, Baroncini S, Ferrari F,Petrini F, et al.. Ciaglia percutaneous dilational tracheostomy. Early and late complications and follow-up.
- Polderman KH, Spijkstra JJ, de Bree R, Christiaans HM, Gelissen HP, Wester JP, Girbes AR, et al.. Percutaneous dilatational tracheostomy in the ICU: optimal organization, low complication rates, and description of a new complication.
- Beiderlinden M, Karl Walz M, Sander A, Groeben H, Peters J, et al.. Complications of bronchoscopically guided percutaneous dilational tracheostomy: beyond the learning curve.
- Berrouschot J, Oeken J, Steiniger L, Schneider D, et al.. Perioperative complications of percutaneous dilational tracheostomy.