K f Allgemeinchirurgie der Philipps-Universit , Marburg, Germany Introduction: The 4-Hydroxy-TEMPO dilatational tracheotomy becomes an increasing number of a standard process in several ICUs. Complications from the dilatational tracheotomy are topic of controversial discussions. The estimation leads from `inappropriate for the critically ill’ as much as `even without surgical background to practice simply and safely’. On the bases in the practical experience of 80 self-practiced dilatational tracheotomies we critically report observed complications, doable complications and in conclusion we present the `quality-standard for dilatational tracheotomy’. Individuals and strategies: Between 12/98 to 8/2000 we initiated a prospective trial on 80 individuals of a 12 bed surgical intensive care unit within a 1100-bed major care hospital, undergoing a dilatational tracheotomy. The free accessible tracheotomy-sets by Portex (onestep-dilatational-system) and Cook (more-step-system) have been utilized. All occuring complications had been documented, for instance fractures of your cartilagines, transfusion requiring bleeding, infection, cubcutaneus emphysema, dislocations of the oral tube, necessity of oral tube adjust and perforation of your cuff through the punction procedure, injuries from the pars membranaceus tracheae or the esophagus with feasible following mediastinitis, rate of conversion to standard tracheotomy, lower of SpO2 through the procedure. Results: In four individuals we found a subcutaneus emphysema which receded spontaneously. Fractures of tracheal cartilagine, dependent on the age of individuals had been observed in six patients. Dislocation in the oral tube occured in 21 (26 ) sufferers and expected instant reposition on the oral tube but led just in one particular case to a short-time decrease with the SpO2 down to 70 mmHg. In the tube-cuff was perforated by punction six instances, but just in one patient the tube had to become changed before continuing the tracheotomy. In 1 patient we PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20718733 detected the punction through the esophagus, the patient remained asymptomatic. In two individuals the procedure had to become converted to a bed-side standard tracheotomy. In a single case resulting from obesity, within the other case triggered by post-traumatic collar hematoma the insertion of the canule, following productive punction, was produced not possible. Transfusion requiring bleeding neither occurred for the duration of insertion, nor at the following change with the canule. We never ever had a Stoma-infection which needed surgical or pharmacological therapy.Conclusion: We established the dilatational tracheotomy within a onestep, or a more-step-technique as a typical procedure in our ICU. The tiny account of complications need to not deceive us by the fact that an abundance of complications could occur. We think about the encounter in traditional tracheotomy as a salvage procedure in tough circumstances and security in emergency re-intubation just like the encounter in bronchoscopy because the regular qualification for everybody who begins the tracheotomy-procedure.PCombination stenting for central airway stenosisJ Nitadori, K Furukawa, N Ikeda, H Tsutsui, H Shimatani, C Konaka, H Kato Department of Surgery, Tokyo Medical University, Tokyo, Japan Objectives: Airway stentings for tracheobronchial stenosis happen to be performed in our institution. We’ve skilled the individuals who underwent insertions of greater than two stents making use of combination of some kind of stents. We demonstrated here the utility of mixture stenting for extreme endobronchial stenosis from our experiences. Method.