title: A modified technique for percutaneous dilatational tracheostomy: A retrospective review of 60 cases.
abstract: BACKGROUND
  We describe a modified technique for percutaneous dilatational tracheostomy (PDT) using intermittent bronchoscopy and ultrasound (US). This method requires 1 single physician operator and no special airway adjuncts. Our aim is to reduce the complications associated with the current popular PDT technique, that is, accidental intraprocedural airway loss, intraprocedural bleeding, and hypoventilation associated with use of continuous bronchoscopy.
  
  
  METHODS
  This is a retrospective review of all PDTs performed on intensive care unit patients at a single nonacademic hospital by a pulmonologist using the modified PDT technique.
  
  
  RESULTS
  Sixty consecutive PDT procedures were performed using the modified technique. Forty-five percent of the patients were considered high-risk individuals for PDT. There were no deaths from the modified PDT procedure. There were no major complications including accidental extubation, major bleeding, posterior tracheal wall laceration, pneumothorax, hemodynamic instability, severe hypoxemia, or infection. The failure rate of PDT was 1.6%. There was no puncture of the bronchoscope, endotracheal tube, or endotracheal tube balloon. All procedures were performed by 1 single physician operator.
  
  
  CONCLUSIONS
  Our modified technique demonstrates a potential to reduce accidental intraprocedural airway loss and intraoperative bleeding associated with PDT while possibly improving gas exchange and saving procedural costs. This technique needs to be comparatively studied with current popular PDT technique in a prospective trial to firmly establish associated risks and benefits.
authors.affiliation: Peninsula Regional Medical Center (PRMC), Pulmonary and Critical Care, Salisbury, MD, 21804. Electronic address: Yashvir@ymail.com.
authors.forename: Yashvir Singh
authors.initials: YS
authors.lastname: Sangwan
authors.affiliation: Peninsula Regional Medical Center (PRMC), Pulmonary and Critical Care, Salisbury, MD, 21804.
authors.forename: Robert
authors.initials: R
authors.lastname: Chasse
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods*; D003422:Critical Care; D004106:Dilatation / Q000379:methods*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods; D055815:Young Adult
keywords: PRMC tracheostomy technique; Percutaneous dilatational tracheostomy; Single physician operator tracheostomy; Ultrasound guided tracheostomy