BEDSIDE PERCUTANEOUS TRACHEOSTOMY IN ACQUIRED-IMMUNODEFICIENCY-SYNDROME

Tracheostomy tube insertion is periodically performed when patients wi th acquired immunodeficiency syndrome (AIDS) require prolonged mechani cal ventilation. In this population, bedside percutaneous tracheostomy may be a better technique than conventional operating room tracheosto my because it reduces procedural cost, requires no patient transport, and requires few sharp instruments, thereby potentially decreasing ris k to surgical staff. A retrospective review was conducted in the Depar tment of Medical Records at St. Vincents Hospital and Medical Center o f New York City. Nine consecutive patients diagnosed with AIDS and und ergoing percutaneous tracheostomy from January a, 1992, to December 31 , 1996, were identified. All patients were males (mean age 32.1 +/- 4 years, CD4 count average 145) and were ventilator-dependent for mean o f 24 +/- 3 days. The procedure was successful and without complication s in all patients. Follow-up was 27 months (range, 1-42 months) and in -hospital mortality was 77 per cent. The average length of survival fo r those patients who died in the hospital was 29 days (range, 3-120). Two patients survived the hospitalization after undergoing decannulati on on postoperative days 29 and 52, respectively. Despite the poor pro gnosis after tracheostomy in patients with AIDS this procedure allows better oral care and may improve patient comfort. Bedside percutaneous tracheostomy can be performed with less risk to surgical personnel an d patient when compared tee conventional surgery. This minimally invas ive procedure safely and efficiently provides prolonged tracheal acces s in patients with AIDS.