BEDSIDE PERCUTANEOUS TRACHEOSTOMY IN CRITICALLY ILL PATIENTS

Bedside percutaneous dilational tracheostomy was performed hy critical care attending physicians or supervised pulmonary and critical care fellows on 100 patients in the ICU at Cook County Hospital, Chicago, over a 3-year period. A needle is inserted in the first or second tracheal interspace followed by a guidewire. The tract is enlarged with a series of dilators to allow placement of a standard tracheostomy tube. Average procedure duration for 46 patients was 6.7 +/- 2.9 min. The intraoperative complication rate was 8 percent: transient oxygen desaturation (4 percent), transient hypotension (3 percent), and paratracheal insertion (1 percent). The postoperative complication rate was 10 percent: bleeding (5 percent), stomal infection (3 percent), and subcutaneous emphysema (2 percent). One patient died of presumed innominate artery rupture. Fifteen of 37 patients who survived hospitalization were decannulated. Stomal closure occurred in 13 of these 15 patients within 3 days with a minimal residual scar. Comparison of percutaneous dilational tracheostomy with two other techniques of percutaneous tracheostomy reveals a similar success rate with a lower incidence of serious complications. Bedside percutaneous dilational tracheostomy can be performed in the ICU by trained physicians with a low complication rate. We believe it to be the procedure of choice for many critically ill patients who require tracheostomies.