title: Prospective study of percutaneous tracheostomy: Role of bronchoscopy and surgical technique.
abstract: OBJECTIVE
  Percutaneous tracheostomy is a common procedure but varies considerably in approach. The aim of our study was to evaluate the need for intraoperative bronchoscopy and to compare various surgical techniques.
  
  
  METHODS
  During 1 year all percutaneous tracheostomies in three intensive care units were prospectively documented according to a unified protocol. In one unit, bronchoscopy was used routinely and in others only during the study.
  
  
  RESULTS
  A total of 111 subjects (77 males) with median age 64 (range, 18-86) years and body mass index 25.4 (range, 15.9-50.7) were included. In unit A, tracheal wall was directly exposed; in unit B, limited dissection to enable tracheal palpation was made. In both units, bronchoscopy was used to check the location of an already inserted guiding needle; needle position required correction in 8% and 12% of cases, respectively. In unit C, in tracheostomies without pretracheal tissue dissection, bronchoscopy was used to guide needle insertion; needle position required correction in 66% of cases. Median duration of operations performed by thoracic surgeons and residents was 10 (range, 3-37) min and by intensive care doctors and residents was 16.5 (range, 3-63) min (p < 0.001). Time from the beginning of preparations for tracheostomy until the end of the whole procedure was median 32 min for bedside tracheostomies and 64 min for operations in the operating theatre (p < 0.001).
  
  
  CONCLUSIONS
  Limited pretracheal tissue dissection enabled proper guiding needle insertion and bronchoscopy was rarely needed. Percutaneous tracheostomies performed by thoracic surgeons took less time, and duration of the whole procedure was remarkably shorter when performed at bedside.
authors.affiliation: Department of Thoracic Surgery, Lung Clinic, Tartu University Hospital, Tartu, Estonia.
authors.forename: Tanel
authors.initials: T
authors.lastname: Laisaar
authors.affiliation: Department of Thoracic Surgery, Lung Clinic, Tartu University Hospital, Tartu, Estonia.
authors.forename: Eero
authors.initials: E
authors.lastname: Jakobson
authors.affiliation: Department of Thoracic Surgery, Lung Clinic, Tartu University Hospital, Tartu, Estonia.
authors.forename: Bruno
authors.initials: B
authors.lastname: Sarana
authors.affiliation: Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia.
authors.forename: Silver
authors.initials: S
authors.lastname: Sarapuu
authors.affiliation: Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia.
authors.forename: Jüri
authors.initials: J
authors.lastname: Vahtramäe
authors.affiliation: Department of Public Health, University of Tartu, Tartu, Estonia.
authors.forename: Mait
authors.initials: M
authors.lastname: Raag
keywords: Tracheostomy; bronchoscopy