Evaluating the neck for percutaneous dilatational tracheostomy.

PURPOSE: The aims of this article are to study how variations in the anatomy of the neck may influence the success of percutaneous dilatational tracheostomy (PDT).

PATIENTS AND

METHODS

Four hundred and ninety-seven patients were included in this study. Patients with a short neck and altered tracheal anatomy were evaluated on the basis of difficulty with PDT, use of long shank tracheostomy tubes, and need for open surgical tracheostomy.

RESULTS

33 (6.6%) patients had an apparently reduced cricoid ring to sternum distance and a deeply lying trachea. Nine of these patients were referred for open surgical tracheostomy. A further five patients had altered tracheal anatomy secondary to disease or surgery. Two of these patients were also referred for open surgical tracheostomy. Thus, unfavourable neck anatomy was responsible for 2.2% (11/497) of patients being referred for open surgical tracheostomy.

CONCLUSION

Variations in the anatomy of the neck can make PDT both difficult and hazardous. Patients with a deeply lying trachea may need a long shank tube. Open surgical tracheostomy is indicated in some patients with a deeply lying trachea and conditions producing secondary deformity of the trachea. All patients should have a detailed history and thorough clinical examination of the neck and thorax prior to PDT. The selective use of chest radiography, MRI, and ultrasound assessment prior to PDT can assist in the identification of patients unsuitable for this technique.