PERCUTANEOUS DILATIONAL TRACHEOSTOMY FOR AIRWAY CONTROL

BACKGROUND: Endoscopic percutaneous dilational tracheostomy (PDT) is a good alternative to obtain safe and secure long-term airway control, and is associated with minimal morbidity and mortality. STUDY DESIGN: During a 14-month period, we prospectively studied 35 intensive care u nit (ICU) trauma patients who underwent early PDT for the sole purpose of obtaining long-term airway control. All patients were determined t o need a tracheostomy owing to extubation inability, need to maintain a patent airway, or need for continuous airway access for management o f secretions, RESULTS: All patients had sustained multiple injuries wi th an average Injury Severity Score (ISS) of 29. The time from ICU adm ission to placement of the PDT was 8 +/- 5 days, The mean Glasgow Coma Scale at the time of the PDT was 10 (range 4 to 15), and 11 patients (31%) had an intracranial pressure device in place. The procedure was completed with bronchoscopic guidance in 33 patients, and in 2 it was converted to surgical tracheostomy (ST). There were no significant com plications associated with the placement of the PDT, Two deaths were d ocumented, neither related to the PDT placement. Compared with standar d ST, charges were reduced by $1,750. CONCLUSIONS: Bedside endoscopic PDT for selected critically ill trauma patients is justified as a safe and effective alternative to ST, The low incidence of complications i n PDT suggests that it can be done safely at bedside in the ICU. (C) 1 997 by Excerpta Medica, Inc.