[Percutaneous tracheostomy: a minimally invasive procedure on the intensive care unit].
BACKGROUND
In 1985 Ciaglia [2] introduced percutaneous tracheostomy as a minimal invasive procedure. Since October 1991 percutaneous tracheostomy has been performed in 40 patients at the University Hospital in Zürich. This paper compares our complication rate using the Cook-system with the conventional open technique in the literature.


METHODS
40 patients, mean 53.6 years of age, 26 male, 14 female. Indications were: inability to perform sufficient bronchial suction, recurrent atelectasis, long term ventilation, difficult or prolonged weaning (i.e. neurotrauma). The tracheal tube is introduced following stepwise dilatation after making skin incision, according to the Seldinger technique.


RESULTS
In all patients tracheostomy was carried out as an elective procedure in the Intensive Care Unit. Time between primary intubation and tracheostomy varied between O and 51 days, mean 15.9 days. Complications occurred in 5/40 cases (12.5%), with only one serious complication: the tracheostoma was misplaced, requiring intubation. Beside that we have seen 2 minor hematomas, 1 bradycardia and 1 subcutaneous emphysema.


CONCLUSIONS
Percutaneous tracheostomy can be safely performed at bedside in the ICU. The method is simple and has a lower complication rate compared to the conventional open technique as reported by Hazard [7] and Griggs [8].
Platz
A
A
Department Chirurgie, Universitätsspital Zürich.
Kleinstück
F
F
Kohler
A
A
Stocker
R
R
Trentz
O
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D009104:Multiple Trauma / Q000628:therapy*; D011786:Quality Control; D012121:Respiration, Artificial / Q000295:instrumentation*; D014139:Tracheostomy / Q000295:instrumentation*
Perkutane Tracheostomie: ein minimal invasives Verfahren auf der Intensivstation.