Fiber optic bronchoscopy-assisted percutaneous tracheostomy: a decade of experience at a university hospital.
OBJECTIVE
To evaluate the efficacy and safety of percutaneous tracheostomy by means of single-step dilation with fiber optic bronchoscopy assistance in critical care patients under mechanical ventilation.


METHODS
Between the years 2004 and 2014, 512 patients with indication of tracheostomy according to clinical criteria, were prospectively and consecutively included in our study. One-third of them were high-risk patients. Demographic variables, APACHE II score, and days on mechanical ventilation prior to percutaneous tracheostomy were recorded. The efficacy of the procedure was evaluated according to an execution success rate and based on the necessity of switching to an open surgical technique. Safety was evaluated according to post-operative and operative complication rates.


RESULTS
The mean age of the group was 64 ± 18 years (203 women and 309 males). The mean APACHE II score was 21 ± 3. Patients remained an average of 11 ± 3 days on mechanical ventilation before percutaneous tracheostomy was performed. All procedures were successfully completed without the need to switch to an open surgical technique. Eighteen patients (3.5%) presented procedure complications. Five patients experienced transient desaturation, 4 presented low blood pressure related to sedation, and 9 presented minor bleeding, but none required a transfusion. No serious complications or deaths associated with the procedure were recorded. Eleven patients (2.1%) presented post-operative complications. Seven presented minor and transitory bleeding of the percutaneous tracheostomy stoma, 2 suffered displacement of the tracheostomy cannula, and 2 developed a superficial infection of the stoma.


CONCLUSIONS
Percutaneous tracheostomy using the single-step dilation technique with fiber optic bronchoscopy assistance seems to be effective and safe in critically ill patients under mechanical ventilation when performed by experienced intensive care specialists using a standardized procedure.
Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile.
Carlos M
CM
Romero
Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile.
Rodrigo
R
Cornejo
Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile.
Eduardo
E
Tobar
Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile.
Ricardo
R
Gálvez
Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile.
Cecilia
C
Luengo
Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile.
Nivia
N
Estuardo
Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile.
Rodolfo
R
Neira
Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile.
José Luis
JL
Navarro
Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile.
Osvaldo
O
Abarca
Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile.
Mauricio
M
Ruiz
Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile.
María Angélica
MA
Berasaín
Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile.
Wilson
W
Neira
Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile.
Daniel
D
Arellano
Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile.
Osvaldo
O
Llanos
D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000379:methods*; D016638:Critical Illness; D005260:Female; D005336:Fiber Optic Technology / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods*