Percutanous dilatational tracheotomy in the ICU: a Norwegian survey focusing on perceived risk and safety attitudes.
OBJECTIVE
Despite its popularity, serious complications do occur with percutaneous dilatational tracheotomy in the ICU. The associated risks in daily practice are probably underestimated and may reflect system flaws in training and team function. This study was performed to obtain an impression of risk perception and safety culture in connection with percutaneous dilatational tracheotomy in Norwegian ICUs.


METHODS
The Medical Director or intensivist on-call in the 30 ICUs participating in the Norwegian Intensive Care Registry was telephone interviewed using a semi-structured questionnaire. Data on the practice of tracheotomy and a qualitative assessment of complications experienced during the last 2 years were collected. In the second part, percutaneous dilatational tracheotomy operators in two ICUs were questioned about their perception of risk with percutaneous dilatational tracheotomy and asked to assess their own abilities as percutaneous dilatational tracheotomy operators and the training they had undergone.


RESULTS
Of the 30 ICUs, 23 used percutaneous dilatational tracheotomy. The majority reported knowledge of severe complications like bleeding, hypoxia and tube dislodgment. Percutaneous dilatational tracheotomy-related deaths were also reported. Operators rated themselves relatively low and indicated the absence of any organized training. They acknowledged the known hazards related to percutaneous dilatational tracheotomy and suggested measures like fibreoptic guidance during the percutaneous dilatational tracheotomy and fewer operators with more experience as well as better team training, to improve patient safety.


CONCLUSIONS
Based on the frequent reporting of serious complications and the suggested safety precautions, we conclude that the percutaneous dilatational tracheotomy is considered a high-risk procedure and that there is still room for improving the safety of this much used ICU procedure.
Sollid
S J M
SJ
Stavanger University Hospital, Division of Acute Care Medicine, Department of Anaesthesia and Intensive Care, Stavanger, Norway. stephen.sollid@safer.net
Strand
K
K
Søreide
E
E
D001294:Attitude to Health; D007722:Health Knowledge, Attitudes, Practice; D006470:Hemorrhage; D006801:Humans; D000860:Hypoxia; D007362:Intensive Care Units; D015233:Models, Statistical; D009664:Norway; D010465:Perception; D015203:Reproducibility of Results; D012306:Risk; D012449:Safety; D011795:Surveys and Questionnaires; D014140:Tracheotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*