title: Bedside percutaneous dilational tracheostomy with endoscopic guidance: experience with 71 ICU patients.
abstract: OBJECTIVE
  To assess the value of endoscopic guidance in bedside percutaneous dilational tracheostomy.
  
  
  METHODS
  The medical critical care unit of a large community hospital.
  
  
  METHODS
  71 consecutive adult patients who required prolonged mechanical ventilation.
  
  
  METHODS
  72 elective percutaneous dilational tracheostomies using the Ciaglia technique were performed under view of a flexible fiberoptic bronchoscope.
  
  
  RESULTS
  Patients were examined during tracheostomy and on days 2 and 7 after the procedure, at discharge and after half a year if they were still alive. A correct median puncture was observed by endoscopic control in 59 interventions. An initial paramedian puncture was detected in 13/72 (18%) procedures and was corrected by renewed insertion in all cases. No severe complications related to percutaneous dilational tracheostomy were noticed. Minor complications occurred in 4/71 (5.6%) patients including minor bleeding in 2, inflammatory infiltration in 1 and one superficial lesion of the posterior tracheal mucosa. Long-term follow-up revealed stomal granulation in 3 patients including one at the tracheal site. At the end of the observation period the tracheostomy still was in use in 14/71 (20%) patients and 12/71 (17%) patients were decannulated. Due to their severe underlying diseases 45/71 (63%) patients had died. To facilitate weaning from the tracheostomy a minitracheostomy tube was used in 3 patients.
  
  
  CONCLUSIONS
  Percutaneous dilational tracheostomy is a simple bedside procedure associated with a low complication rate. We recommend the use of endoscopic guidance to increase the safety of tracheal puncture and dilation procedure.
authors.affiliation: 2nd Medical Department, Krankenanstalt Rudolfstiftung, Vienna, Austria.
authors.forename: W B
authors.initials: WB
authors.lastname: Winkler
authors.forename: R
authors.initials: R
authors.lastname: Karnik
authors.forename: O
authors.initials: O
authors.lastname: Seelmann
authors.forename: J
authors.initials: J
authors.lastname: Havlicek
authors.forename: J
authors.initials: J
authors.lastname: Slany
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D004106:Dilatation; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods*