BRONCHOSCOPIC GUIDANCE MAKES PERCUTANEOUS TRACHEOSTOMY A SAFE, COST-EFFECTIVE, AND EASY-TO-TEACH PROCEDURE

Background. We wanted to assess the efficiency of instituting a modifi ed technique of percutaneous tracheostomy (PET) with bronchoscopic gui dance. Methods. During a 10-month period 48 consecutive trauma patient s requiring tracheostomy were divided between a standard tracheostomy control group (ST) and a PET group. All patients were followed prospec tively. The hospital charges were reviewed retrospectively. Results. A ge, gender body habitus, and principal diagnosis were similar in the 2 1 ST patients and the 27 PET patients. All STs and 15 of the PETs were performed in the operating room (OR), and the 12 remaining PETs were done in the intensive care unit (ICU). Four patients in the ST group a nd six in the PET group died. One of these deaths occurred in a patien t in the PET group with severe adult respiratory distress syndrome. Pr ocedure time was shorter for PET (16 versus 45 minutes, p < 0.0001). J unior residents performed more PETs than STs (33% versus 10%), and PET was considered ''easier'' to perform than ST (81% versus 47%). Hospit al charges for PET in the ICU were $3400 less per patient compared wit h ST or PET in the OR. Conclusions. PET was performed easily and safel y in the OR and at the ICU bedside. PET required one-third the time of ST. Bronchoscopic supervision of PET may have contributed to the smal l number of complications and the educational experience of junior res idents. PET in the ICU can reduce hospital charges significantly and a voids transport of patients to the OR. PET is as safe as ST and should be considered the procedure of choice for an ICU patient requiring an elective tracheostomy.