PERCUTANEOUS TRACHEOSTOMY FOR CRITICALLY ILL PATIENTS - TECHNIQUE ANDRESULTS OF A MINIMALLY INVASIVE METHOD

The so-called percutaneous dilatational tracheostomy-essentially a min imally invasive puncture method - inserting the tracheal cannula by a modified Seldinger-technique is an alternative method to the conventio nal operative tracheostomy. The percutaneous dilatational tracheostomy was evaluated in a prospective trial (June 92 - January 93) on 50 con secutive surgical (n = 36), medical (n = 10), and neurological-neurosu rgical (n = 4) critically ill patients (29 m, 21 f; age 14 - 87 years) with need for prolonged mechanical ventilation. After an average dura tion of endotracheal intubation of 6 (0 - 22) days, the procedure was endoscopically guided and controlled via the endotracheal tube. An 8 m m cannula was inserted in each case. Eight patients had severe thrombo cytopenia (less-than-or-equal-to 50.000 Plt./muL). The percutaneous tr acheostomy was always performed with success. The average procedure du ration was 8 (5 - 15) minutes. The perioperative complications were: o ne patient died of acute cardiac failure independent from the method o f tracheostomy, one sustained a temporary subcutaneous emphysema and o ne a minor bleeding. During a mean duration of cannulation of 21 (0 - 113) days only one bleeding from the skin margin was observed postoper atively. Infection of stoma site, misplacement of cannula, rupture of the tube cuff, and pneumothorax were not noticed. On 13 decannulated p atients stenosis of the trachea was not found in a period of 6 - 8 wee ks following the tracheostomy. As a bedside procedure the percutaneous dilatational tracheostomy is safe and quick and should therefore be t he method of choice for critically ill patients who require a tracheos tomy.