ELECTIVE BEDSIDE TRACHEOSTOMY IN THE INTENSIVE-CARE UNIT

BACKGROUND: Tracheostomy is a frequently performed procedure, and hist orically has had a high reported complication rate. This has led some authors to suggest that a tracheostomy should be done only in the oper ating room (OR). Concerns regarding the hazards of transporting critic ally ill patients to the OR may inhibit the use of tracheostomy. Bedsi de tracheostomy in the Intensive Care Unit (ICU) has been shown to be safe, but this concept has not been widely accepted. STUDY DESIGN: We retrospectively reviewed consecutive patients undergoing tracheostomy over a four-year period and compared the safety of elective beside tra cheostomy with OR tracheostomy. RESULTS: We studied 536 patients who u nderwent tracheostomy during the four years, in 470 of whom the proced ures were elective. Of these, 66 percent were done at the bedside with out an anesthesiologist present. For the 311 patients who underwent be dside tracheostomy, the complication rate was 8.7 percent compared to 9.4 percent of 159 patients undergoing OR tracheostomy (p values were not significant). No deaths were directly associated with tracheostomy procedures, although the overall hospital mortality rate for these pa tients was 59 percent. CONCLUSIONS: A tracheostomy can safely be perfo rmed in an ICU without requiring transport of the patient to the opera tic; suite, thereby eliminating the hazards of transport.