The utility of chest radiography following percutaneous dilational tracheotomy.

Objective: To determine the need for routine chest radiography following percutaneous dilational tracheotomy (PDT).

Design: Retrospective chart review.

Setting: Tertiary care academic medical center.

Patients: The records of 119 patients undergoing PDT between 1993 and 2000 for indications of prolonged intubation or need for pulmonary toilet. All patients received a portable chest radiograph immediately following the procedure.

Outcome Measure: Incidence of postoperative pneumothorax or pneumomediastinum.

Results: One patient (0.8%) undergoing PDT experienced a postoperative pnuemothorax. This patient was noted to have respiratory distress within 10 minutes following the procedure, suggesting a pneumothorax. A postoperative chest radiograph confirmed the clinical impression. No asymptomatic patients were diagnosed as having a pnuemothorax or pneumomediastinum using postoperative chest radiography.

Conclusions: Chest radiography following PDT is indicated when there are clinical findings suggesting pneumothorax or pneumomediastinum. Without clinical signs or symptoms, routine use of postoperative chest radiographs are unnecessary and not cost-effective.