Percutaneous dilatational tracheostomy: Still a surgical procedure

Although percutaneous dilatational tracheostomy (PDT) has been shown to be a cost-effective bedside alternative to open tracheostomy (OT), prior repor ts of the complications of the procedure are contradictory. Reported compli cations range from minor events to fatal ones, in varying percentages. This prospective study was designed to identify the type and severity of compli cations accompanying the introduction of PDT to a tertiary medical center. Surgical and medical intensive care unit (ICU) patients requiring elective tracheostomy were identified as appropriate for PDT using approved institut ional criteria. All procedures were performed at an ICU bedside in the pres ence of a surgeon privileged to perform OT. Demographic data, procedural in formation, and patient outcome (including minor and major complications, le ngth of stay, and survival) were collected. PDT was performed in 96 ICU pat ients, with complete data available for 95 patients. PDT was performed in a n average of 13.1 +/- 1.0 minutes. Twenty-three major and minor complicatio ns occurred, including two perioperative deaths, in 15 patients (15.8%). A total of 37 PDT patients (38.9%) died in the hospital, indicative of the se verity of illness of patients requiring tracheostomy. Based on the experien ce to date, Cedars-Sinai Medical Center (Los Angeles, CA) continues to requ ire a surgeon privileged to perform OT to participate in all PDT procedures .