Safety of percutaneous dilational tracheostomy in patients ventilated with high positive end-expiratory pressure (PEEP).
OBJECTIVE
To assess the impact of bronchoscopically guided percutaneous dilational tracheostomy (PDT) on oxygenation in patients with severe respiratory failure ventilated with high positive end-expiratory pressure (PEEP).


METHODS
Prospective clinical study.


METHODS
Anaesthesiological ICU, referral centre for acute respiratory distress syndrome (ARDS) therapy, university hospital.


METHODS
Mechanically ventilated patients with indication for PDT. Two hundred three consecutive PDTs were performed in 198 patients on either high (>10 mbar, n=88) or low (</=10 mbar, n=115) PEEP under bronchoscopic guidance. Arterial blood gas tensions were measured immediately before and 1 and 24 h after PDT.


RESULTS
Positive end-expiratory pressure averaged 16.6+/-4 mbar in the high PEEP and 7.6+/-2.2 mbar in the low PEEP group. In the high PEEP group the PaO(2)/FIO(2 )ratio was lower (243+/-90 vs 285+/-78 mmHg) and PaCO(2) higher (45+/-9.4 vs 39+/-7.1 mmHg) when compared to the low PEEP group. Nevertheless, PDT did not significantly decrease oxygenation in either group 1 and 24 h after PDT (PaO(2)/FIO(2): 223+/-83 and 260+/-86 mmHg in the high PEEP group and 280+/-88 and 302+/-82 mmHg in the low PEEP group, respectively). Furthermore, oxygenation did not deteriorate with PDT even in patients with gravely impaired gas exchange (lowest quartile) with a PaO(2)/FIO(2) averaging 130+/-42 mmHg (range 45-192 mmHg) at a PEEP of 17+/-4 mbar.


CONCLUSIONS
Bronchoscopically guided PDT in our patients on high PEEP did not jeopardise oxygenation 1 h and 24 h following PDT. Accordingly, high PEEP and hypoxic respiratory failure should not be considered a general contraindication for PDT.
Beiderlinden
Martin
M
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 , Essen, Germany. martin.beiderlinden@uni-essen.de.
Groeben
Harald
H
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 , Essen, Germany.
Peters
Jürgen
J
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 , Essen, Germany.
D000328:Adult; D000704:Analysis of Variance; D001784:Blood Gas Analysis; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods*; D004106:Dilatation / Q000009:adverse effects / Q000379:methods*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D018579:Patient Selection; D010976:Platelet Count; D011030:Pneumothorax / Q000209:etiology; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D011517:Prothrombin Time; D011659:Pulmonary Gas Exchange; D012131:Respiratory Insufficiency / Q000378:metabolism / Q000628:therapy*; D012449:Safety; D012720:Severity of Illness Index; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome