Percutaneous dilational tracheostomy for airway control.
BACKGROUND
Endoscopic percutaneous dilational tracheostomy (PDT) is a good alternative to obtain safe and secure long-term airway control, and is associated with minimal morbidity and mortality.


METHODS
During a 14-month period, we prospectively studied 35 intensive care unit (ICU) trauma patients who underwent early PDT for the sole purpose of obtaining long-term airway control. All patients were determined to need a tracheostomy owing to extubation inability, need to maintain a patent airway, or need for continuous airway access for management of secretions.


RESULTS
All patients had sustained multiple injuries with an average Injury Severity Score (ISS) of 29. The time from ICU admission to placement of the PDT was 8 +/- 5 days. The mean Glasgow Coma Scale at the time of the PDT was 10 (range 4 to 15), and 11 patients (31%) had an intracranial pressure device in place. The procedure was completed with bronchoscopic guidance in 33 patients, and in 2 it was converted to surgical tracheostomy (ST). There were no significant complications associated with the placement of the PDT. Two deaths were documented, neither related to the PDT placement. Compared with standard ST, charges were reduced by $1,750.


CONCLUSIONS
Bedside endoscopic PDT for selected critically ill trauma patients is justified as a safe and effective alternative to ST. The low incidence of complications in PDT suggests that it can be done safely at bedside in the ICU.
Carrillo
E H
EH
Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA.
Spain
D A
DA
Bumpous
J M
JM
Schmieg
R E
RE
Miller
F B
FB
Richardson
J D
JD
D000328:Adult; D003422:Critical Care; D004724:Endoscopy / Q000191:economics; D005260:Female; D017722:Hospital Charges; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D009104:Multiple Trauma / Q000628:therapy; D011446:Prospective Studies; D014139:Tracheostomy / Q000191:economics / Q000379:methods*