BEDSIDE PERCUTANEOUS TRACHEOSTOMY WITH BRONCHOSCOPIC GUIDANCE IN CRITICALLY ILL PATIENTS

Background: Bedside percutaneous dilational tracheostomy, a relatively new method of tracheal cannulation, provides safe and ready access to the trachea to relieve airway obstruction and tracheopulmonary secret ions. The dilational technique has undergone various modifications dur ing the past decade. Complications of this procedure are primarily rel ated to the lack of direct visualization during tracheostomy tube plac ement and to poor patient selection. Objective: To report the utility of percutaneous dilational tracheostomy with bronchoscopic guidance in 162 critically ill patients. Main Outcome Measures: Mortality rates a nd complications associated with this technique. Results: Twenty-five patients (15.4%) died while hospitalized. No deaths were related to tr acheostomy. There were four (2.5%) major complications: one pneumothor ax and three posterior tracheal tears, which healed spontaneously. The re were five (3.1%) minor complications: one posterior mucosal disrupt ion, one minor bleeding episode, and three minor episodes of celluliti s. One hundred thirty-seven patients (84.6%) were discharged. Twenty-n ine patients (21.2%) were available for follow-up and were experiencin g no significant problems or complications following the procedure. Co mpared with standard open tracheostomy, charges were reduced by $1628. 20 per patient ($263 768.40 total savings). Conclusion: Bedside percut aneous tracheostomy with bronchoscopic guidance is safe and cost-effec tive. Complications compare favorably with that of open tracheostomy. Major complications should be avoided with continuous bronchoscopic ob servation during the procedure.