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Emerg Med J. 2007 July; 24(7): 493–494.
PMCID: PMC2658400

Routine chest x rays following bronchoscopy guided percutaneous dilational tracheostomy

Routine chest x rays following bronchoscopy guided percutaneous dilational tracheostomy

Report by Souvik Das, SHO

Checked by: Mick Jennings, Consultant

Lewisham University Hospital, London, UK

Abstract

A short cut review was carried out to establish whether routine chest x rays are required following bronchoscopy guided percutaneous dilational tracheostomy (PDT). A total of 393 citations were reviewed of which six answered the three part question. The clinical bottom line is that at present there is no clinical evidence to support routine postprocedure chest x ray following bronchoscopy guided percutaneous dilatianal tracheostomy.

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 PDT was performed. There were no clinical signs to suggest immediate postoperative complications like pneumothorax, pneumomediastinum or malposition of the tracheostomy tube. You wonder whether a chest x ray is appropriate to rule out the above mentioned complications.

Search strategy

Medline 1966–05/07 using the Ovid interface: [percutaneous.mp. OR seldinger.mp.] AND [tracheostomy.mp. OR exp tracheostomy/OR tracheostom$.mp.. OR exp tracheotomy/] AND [exp postoperative complications/OR complications.mp.] LIMIT to human.

Search outcome

Altogether 393 papers were found, six of which were relevant to the three part question (table 22).

Table thumbnail
Table 2

Comment(s)

The study of Hoehne et al and Datta et al are retrospective, so the evidence base is limited. Although all these six studies are based on small numbers of patients, it is apparent that all these studies unanimously agree on the following point. There is no benefit in doing routine chest x rays to rule out immediate postoperative complications like pneumothorax, pneumomediastinum and malposition of tube, following bronchoscopy guided PDT.

Clinical bottom line

At present there is no clinical evidence to support routine post‐procedure chest x ray following bronchoscopy guided percutaneous dilational tracheostomy. But a larger study may be required to answer this definitively.

References

  • Berrouschot J, Oeken J, Steiniger L. et al. Perioperative complications of percutaneous dilational tracheostomy. Laryngoscope 1997;107:1538-44. [PubMed]
  • Beiderlinden M, Karl Walz M, Sander A. et al. Complications of bronchoscopically guided percutaneous dilational tracheostomy: beyond the learning curve. Intensive Care Med 2002;28:59-62. [PubMed]
  • Datta D, Onyirimba F, McNamee M J. et al. The utility, of chest radiographs following percutaneous dilational tracheostomy. Chest 2003;123:1603-6. [PubMed]
  • Gambale G, Cancellieri F, Baldini U. et al. Percutaneous dilational tracheostomy. Early and late complications and follow-up. Minerva Anestesiol 2003;69:825-30;830-3. [PubMed]
  • Polderman K H, Spijkstra J J, de Bree R. et al. Percutaneous dilatational tracheostomy in the ICU: optimal organization, low complication rates, and description of a new complication. Chest 2003;123:1595-602. [PubMed]
  • Hoehne F, Ozaeta M, Chung R. et al. Routine chest X-ray after percutaneous tracheostomy is unnecessary. Am Surg 2005;71:51-3. [PubMed]

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