Chest radiographs after dilatational percutaneous tracheotomy: Are they necessary?

BACKGROUND: The efficacy of routinely obtaining chest radiographs after sta ndard open tracheotomy has been questioned. Recent literature would suggest that after a routine, uncomplicated tracheotomy, chest radiography is a lo w-yield procedure that incurs unnecessary expense. Percutaneous dilatationa l tracheotomy (PDT) is rapidly replacing open tracheotomy as the intensive care unit procedure of choice for airway management, Complication rates are equivalent between the two procedures. OBJECTIVE: We examined the value and cost-effectiveness of routine postoper ative chest radiographs in patients undergoing PDT. STUDY DESIGN AND SETTING: The study was a prospective analysis of 54 consec utive PDTs performed at a tertiary care academic institution. RESULTS: Eighteen (33%) patients had chest radiographs obtained within 1 ho ur of PDT (6 at the request of the otolaryngology service); 35 (66%) underw ent radiography more than 2 hours later at the request of the intensive car e unit for reasons other than PDT. There were no incidents of pneumothorax, pneumomediastinum, or tracheotomy tube malposition in any patient. Patient s undergoing chest radiography within 1 hour of the PDT also had chest radi ographs within 12 hours at the request of ICU staff for their underlying di sease. CONCLUSIONS: Routine chest radiography after PDT is of low yield. Because m ost of these patients require chest radiographs for their underlying diseas e within 12 hours, a cost savings of approximately $13,500 would be realize d in this patient population, SIGNIFICANCE: Routine chest radiography after PDT is unwarranted in most ca ses.