Safety and efficiency of interventional pulmonologists performing percutaneous tracheostomy.
BACKGROUND
The steady rise in the number of critically ill patients in the USA has led to an increase in the need for tracheostomies in patients requiring chronic ventilatory support. There is a matched need for experienced operators to safely and efficiently perform these procedures.


OBJECTIVE
We evaluated the effects on procedural outcomes and efficiency of percutaneous dilatational tracheostomy (PDT) placement in the medical intensive care unit (MICU) by the surgical team (ST) or interventional pulmonologists (IP). The IP team joined the PDT team in September 2007 and became primarily responsible for all PDT in the MICU.


METHODS
A retrospective analysis of prospectively collected data of patients who received PDT in the MICU by ST and IP from September 2007 to August 2010 was made. Outcomes including safety, efficacy, and procedural efficiency were compared.


RESULTS
One hundred seven patients underwent bedside PDT in the MICU during this period. Forty-three procedures (40.2%) were performed by the ST and 64 procedures (59.8%) were performed by IP. There was no statistical difference between the incidence of airway injury and infection between the two procedural groups. There were no deaths related to the performance of PDT in our series. PDT was completed within 48 h of request in 100% of IP patients and 95% of ST patients (p = 0.08).


CONCLUSIONS
There were no statistical differences in PDT between the ST and IP groups when comparing complications. There was a trend towards an increased efficiency in time to PDT after consultation within the IP PDT group. Trained IP can safely and effectively perform PDT.
Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, The Johns Hopkins University, Baltimore, MD 21205, USA. lyarmus@jhmi.edu
Lonny
L
Yarmus
Vinciya
V
Pandian
Christopher
C
Gilbert
Adam
A
Schiavi
Adil
A
Haider
Albert
A
Chi
Athir
A
Morad
Christina
C
Miller
David
D
Efron
Kent
K
Stevens
Shravani
S
Gangidi
Ravi
R
Vaswani
Elliott
E
Haut
Marek
M
Mirski
Nasir
N
Bhatti
David
D
Feller-Kopman
D016638:Critical Illness / Q000628:therapy; D004106:Dilatation / Q000009:adverse effects / Q000379:methods / Q000592:standards; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D008134:Long-Term Care / Q000379:methods; D010348:Patient Care Team / Q000592:standards*; D061214:Patient Safety; D011183:Postoperative Complications / Q000517:prevention & control*; D015272:Pulmonary Medicine / Q000379:methods / Q000592:standards; D012121:Respiration, Artificial / Q000379:methods; D013903:Thoracic Surgery / Q000379:methods / Q000592:standards; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods / Q000592:standards; D016896:Treatment Outcome