An analysis of time and staff utilization for open versus percutaneous tracheostomies.
OBJECTIVE
We examined staff utilization and procedure length for percutaneous and open bedside tracheostomies in an intensive care setting.


METHODS
Prospective clinical outcomes study.


METHODS
Intensive care unit (ICU) tracheostomy consults meeting criteria for bedside procedures were randomized to open or percutaneous procedures. The Cook percutaneous kit and a prepackaged tracheostomy tray were used. ICU nursing and respiratory therapy staff was present for all procedures. The total resident time, staff time, and procedure length were recorded. Twelve patients underwent percutaneous tracheostomy, and 12 received an open tracheostomy.


RESULTS
An operating room nurse was present for 7 of the open procedures. Ancillary medical staff was present for 3 open tracheostomies: anesthesia for 2 and critical care for 1. Ancillary medical staff was present for 4 percutaneous tracheostomies: anesthesia staff for 1 and critical care for 3. The average resident presence, staff presence, and procedure length for open tracheostomies were 47, 30, and 12 minutes, respectively. For percutaneous tracheostomies, the times were 39, 29, and 12 minutes, respectively. One intraoperative complication occurred during a percutaneous procedure and 2 perioperative complications occurred: 1 in the open group and 1 in the percutaneous group.


CONCLUSIONS
There was no significant difference in procedure length, resident time, or staff time between the 2 procedures. Ancillary staff was occasionally used but was not thought to be necessary for the majority of procedures. Both procedures can be safely and expediently performed in the ICU.
Kaylie
David M
DM
Ear Foundation, Nashville, Oregon Health and Science University, Portland 97239, USA.
Andersen
Peter E
PE
Wax
Mark K
MK
D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003422:Critical Care / Q000379:methods; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013514:Surgical Procedures, Operative; D013997:Time Factors; D014139:Tracheostomy / Q000379:methods* / Q000706:statistics & numerical data*