Bedside percutaneous dilational tracheostomy with endoscopic guidance: experience with 71 ICU patients.
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.
Winkler
W B
WB
2nd Medical Department, Krankenanstalt Rudolfstiftung, Vienna, Austria.
Karnik
R
R
Seelmann
O
O
Havlicek
J
J
Slany
J
J
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*