Open bedside tracheostomy: routine procedure for patients under prolonged mechanical ventilation.
BACKGROUND
Tracheostomy is electively performed in critically ill patients requiring prolonged respiratory support. The risk of transporting, the increasing associated cost and operative room schedule are some of the obstacles for wider acceptance of this procedure. The use of rigid selection criteria exclude many patients who would benefit of this approach.


OBJECTIVE
To determine the safety of open bedside tracheostomy (OBT) as a routine intensive care units (ICU) procedure without any selection criteria, considering its peri and postoperative complications.


METHODS
Retrospective medical chart review of all patients that underwent elective tracheostomy between April 1999 and December 2005 at ICU of three private hospitals.


RESULTS
The study group comprised 552 patients with a mean age of 69.6 +/- 15.8 years. The incidence of significant complications (until 30 days after the procedure) was 4.34% (24 cases): 9 minor bleeding, 9 major bleeding, 2 subcutaneous emphysema, 4 stomal infections. Late complications were: laryngotracheal stenosis in 2 and tracheoinomminate fistula in 1 patient.


CONCLUSIONS
OBT seems to be a safe and simple procedure, when performed by a team of experienced physicians under controlled circumstances, and should be considered as an option for ICU patients.
Terra
Ricardo Mingarini
RM
Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil. rmterra@uol.com.br
Fernandez
Angelo
A
Bammann
Ricardo Helbert
RH
Castro
Ana Cristina P
AC
Ishy
Augusto
A
Junqueira
Jader Joel Machado
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data