Percutaneous dilational tracheostomy in a community intensive care unit

Purpose: Percutaneous dilational tracheostomy (PDT) is increasingly being used to replace traditional surgical tracheostomy (ST) in the management of critically ill patients. There is considerable controversy regarding the safety of this procedure in the hands of non-surgeons, and most data so far have come from large tertiary care centres. We report our experience and safety data in the implementation of a PDT program for critically ill patients in a teaching community hospital in an attempt to demonstrate that this procedure can be performed safely outside of an academic ICU. Methods: Prospective observational study in a large community teaching hospital. All patients without contraindications were considered for enrollment. Contraindications to PDT included evidence of infection at the surgical site, the presence of a coagulopathy not correctable to an international normalized ratio of less than 1.5, or unstable cervical spine injuries. A total of 42 patients were included in the study and all received PDT using the Ciaglia Blue Rhino single dilator introducer set (Cook Critical Care, Bloomington, IN, USA). Data collected included patient age, sex, reason for intubation, and complications. Results: Of 42 patients, 25 were males, and 17 were females. The average age was 47.6 years (range 16-87 years). The commonest admitting diagnosis was traumatic brain injury, followed by sepsis and cardiac arrest. Our total recorded complication rate was 7.1%, with no deaths. There were two episodes of transient hypotension (4.8%). Conclusion: Percutaneous dilational tracheostomy appears to be at least as safe as traditional ST, and may have advantages with respect to timeliness and minimization of patient transport. The complication rate seen in our program is similar to that seen in other PDT series.