To review a single institution’s experience in the treatment of patients requiring long-term airway access.
Medical and surgical patients requiring tracheostomy were evaluated by a single surgeon. A decision for bedside percutaneous versus open tracheostomy was based on hemodynamic stability, patient anatomy, and coagulation profile.
A total of 131 patients underwent a planned percutaneous tracheostomy between 11/05/2001 and 04/12/2005. There were 74 men and 57 women, with an average age of 66.1 ± 16.5 yrs (median = 71). The duration of mechanical ventilation prior to tracheostomy was 16.1 ± 8.7 d (median = 15). The majority of patients received a size #8 tube (n = 117), and the remainder a size #7 tube. There was one death in post-operative period (i.e., within 30 d of the procedure) secondary to bleeding into the airway after the tracheostomy was downsized. One procedure required conversion to an open procedure due to excessive bleeding. Complications included three bedside explorations for bleeding (tracheostomy completed successfully), one case of bleeding on POD #2 with a respiratory arrest who was resuscitated successfully and had no further intervention, one semi-open procedure at the bedside secondary to morbid obesity, and four cases done percutaneously in the OR for patient issues. Of the 130 procedures performed successfully, 50 were done in a post-operative setting and the remainder (n = 80) done for medical conditions.
Percutaneous tracheostomy is a widely employed technique used by surgeons, pulmonologists, and critical care physicians to provide long-term airway access for patients requiring protracted weaning from mechanical ventilation. It generally does not require use of operating room facilities, and in skilled hands is safe and reliable. Our series demonstrates common complications encountered during this procedure and should be kept in mind by those physicians who are learning this procedure.
Physicians performing percutaneous tracheostomy should be prepared to manage issues of bleeding and emergent airway access in the event of complications when performing this procedure.
Francis Podbielski, None.