PURPOSE: Intensive Care Unit (ICU) patients, mainly those in need of prolonged mechanical ventilation, may require a tracheotomy which once was done in the operating room. Percutaneous dilatational tracheotomy was first described in 1985 and now is a well-established procedure that can be performed at the bedside by an intensivist with less surgical equipment required. To evaluate the safety of performing a percutaneous dilatational tracheotomy (PDT) with fiberoptic bronchoscopy assistance in patients requiring prolonged mechanical ventilation.
METHODS: Ninety two patients 17-81yrs of age, 38 females and 54 males underwent PDT due to prolonged endotracheal intubation between December 2009 and May 2011. The procedures of percutaneous dilatation tracheotomy with Guide Wire Dilating Forceps (GWDF) were done bedside with bronchoscopic guidance under general anesthesia in the ICU. Interventional and post interventional complications were observed.
RESULTS: Overall complication rate was low and occurred in seven patients (7,6%), and there was no procedure-related mortality. Subcutaneous emphysema without pneumothorax occurred in one patient. One patient had a transitory hypotension related to sedation, and five patients had been peristomal oozing. The mean time for procedure completion was 16 minutes, and no patient required conversion to a surgical tracheotomy. The bronchoscopic examination that was performed in 46 of the patients 20 days after tracheotomy tube removal showed no scar formation.
CONCLUSIONS: PDT with bronchoscopic guidance is a safe and easy procedure that can be done by an intensivist at the bedside setting of an ICU.
CLINICAL IMPLICATIONS: Whether to use PDT or surgical tracheostomy (ST) is still a matter of debate. Recent literature suggests that PDT offers several potential advantages, and many specialists in intensive care view it as the method of choice for critically ill patients who require tracheostomy. It is easily performed, efficient and above all Safe.
DISCLOSURE: The following authors have nothing to disclose: Kyriaki Tsikritsaki, Georgios Koukoulitsios, Agisilaos Dervas, Maria Kryfti, Ioannis Dimitroulis
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