[Bedside percutaneous tracheostomy in critically ill medical patients: clinical characteristics, outcome and complications].
BACKGROUND
Tracheostomy is a surgical procedure, frequently used in patients with respiratory failure requiring prolonged mechanical ventilation. It is associated with fewer complications and may facilitate weaning from mechanical ventilation. Over the past 15 years, bedside percutaneous tracheostomy (PDT) has been widely employed as the primary method for performing tracheostomy in intensive care units. However, the ideal technique and timing for this procedure is still controversial.


OBJECTIVE
To characterize the patients who underwent bedside percutaneous tracheostomy (PDT) in the Medical Intensive Care Unit (MICU) in terms of complications, clinical characteristics upon admission, short and long term outcome.


METHODS
This retrospective cohort study included all patients hospitalized at the MICU from January 2003 to December 2007 who underwent bedside PDT. The patients' demographic data, past diagnosis, reason for admission to the ICU and a wide variety of data regarding procedure performance and complications were retrieved from the patients' charts. The information was subsequently computerized and analyzed.


RESULTS
The study population included 126 patients who underwent bedside PDT. Overall, 63.5% were men and the average age was 59.8 years. Patients who survived for 30 days after the procedure had a lower burden of background morbidity as reflected by their Charlson score. The one year mortality rate was 56.6%, of which 70% of the patients died in the first month following the procedure. Overall complication rate was low and occurred in 9 patients (7.1%). There was no procedure-related mortality. The most common pathogens isolated from patients' sputum were Acinetobacter spp. and Pseudomonas aeruginosa. The survival rate was highest among the group of patients who underwent tracheostomy during the first 10 days after initiation of mechanical ventilation.


CONCLUSIONS
Bedside PDT is a simple, safe and readily available procedure with low morbidity rates when performed by an experienced operator. However, long term outcome remains poor Survival rates were lower among patients who underwent the procedure within ten days of mechanical ventilation.
Binyamin
Yair
Y
Soroka University Medical Center, Beer Sheba.
Frenkel
Amit
A
Barski
Leonid
L
Novack
Victor
V
Almog
Yaniv Y
YY
D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems / Q000592:standards*; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D015996:Survival Rate; D014139:Tracheostomy / Q000379:methods* / Q000401:mortality