BEDSIDE PERCUTANEOUS DILATIONAL TRACHEOSTOMY WITH ENDOSCOPIC GUIDANCE- EXPERIENCE WITH 71 ICU PATIENTS

Objective: To assess the value of endoscopic guidance in bedside percu taneous dilational tracheostomy. Design: The medical critical care uni t of a large community hospital. Setting: 71 consecutive adult patient s who required prolonged mechanical ventilation. Interventions: 72 ele ctive percutaneous dilational tracheostomies using the Ciaglia techniq ue were performed under view of a flexible fiberoptic bronchoscope. Me asurements and results: Patients were examined during tracheostomy and on days 2 and 7 after the procedure, at discharge and after half a ye ar if they were still alive. A correct median puncture was observed by endoscopic control in 59 interventions. An initial paramedian punctur e was detected in 13/72 (18%) procedures and was corrected by renewed insertion in all cases. No severe complications related to percutaneou s dilational tracheostomy were noticed. Minor complications occurred i n 4/71 (5.6%) patients including minor bleeding in 2, inflammatory inf iltration in 1 and one superficial lesion of the posterior tracheal mu cosa. Long-term follow-up revealed stomal granulation in 3 patients in cluding one at the tracheal site. At the end of the observation period the tracheostomy still was in use in 14/71 (20%) patients and 12/71 ( 17%) patients were decannulated. Due to their severe underlying diseas es 45/71 (63%) patients had died. To facilitate weaning from the trach eostomy a minitracheostomy tube was used in 3 patients. Conclusion: Pe rcutaneous dilational tracheostomy is a simple bedside procedure assoc iated with a low complication rate. We recommend the use of endoscopic guidance to increase the safety of tracheal puncture and dilation pro cedure.