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Report by Souvik Das, SHO
Checked by: Mick Jennings, Consultant
Lewisham University Hospital, London, UK
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.
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].
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.
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.
Altogether 393 papers were found, six of which were relevant to the three part question (table 22).
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.
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.