Repeat percutaneous dilatational tracheostomy in an awake and unintubated patient

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Bedside percutaneous dilatational tracheostomy (PDT) has become an accepted method for securing airways in patients requiring prolonged ventilatory support. Repeat PDT in patients who have had a tracheostomy earlier is considered a relative contraindication as a result of distorted anatomy. Three case series have been reported supporting the safety of repeat bedside PDT in experienced hands, but there is no previously published data regarding repeat PDT in awake and unintubated patients. We report a case in which a repeat PDT was done on an awake 20-year-old female patient with cerebral palsy and kyphoscoliosis admitted owing to pneumonia and respiratory failure. This facilitated tracheal toilet in this patient without resorting to general anaesthesia and mechanical ventilation. In conclusion, both repeat PDT and awake PDT, both separately or together, can be very useful in the management of critical care and pre-critical care patients and merit wider use.

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