• Marianne Meyer, Jonathan Critchlow, Naresh Mansharamani, Luis F Angel, Robert Garland, and Armin Ernst.
• Pulmonary Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
• Crit. Care Med. 2002 May 1; 30 (5): 986-8.

ObjectivePrevious tracheostomy has been considered a relative contraindication for percutaneous dilational tracheostomy. The objective of this study was to assess the safety of percutaneous dilational tracheostomy in critically ill patients with a history of previous tracheostomy.DesignRetrospective, single-center case series of all consecutive patients requiring repeat tracheostomy for continued mechanical ventilatory support.SettingIntensive care unit of a tertiary-care referral center.SubjectsFourteen patients (eight female, six male) with a median age of 70 yrs (range, 33-94). All patients had previously undergone tracheostomy.InterventionBedside percutaneous dilational tracheostomy.Measurement And Main ResultsSubjects' previous tracheostomies dated back between 10 days and 8 yrs. Present intubation time before percutaneous dilational tracheostomy varied between 4 and 30 days. Bedside percutaneous dilational tracheostomy was performed successfully in all 14 patients by trained pulmonologists and surgeons. Eleven patients received an 8-mm and three received a 7-mm tracheostomy tube. There were no significant periprocedural complications, and no patient required surgical revision. The only postprocedural complication was accidental decannulation in one patient, which was managed with repeat percutaneous dilational tracheostomy.ConclusionsTrained physicians can safely perform bedside percutaneous dilational tracheostomy after previous tracheostomy. Percutaneous dilational tracheostomy offers an alternative to surgical tracheostomy in this particular patient population and should not be considered contraindicated.

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