Elective percutaneous tracheostomy for long-term ventilation in a cardiological intensive care unit

Background and objective: Long-term mechanical ventilation presents a probl em in an intensive care unit (ICU). If done via oral intubation it brings t he danger of bacterial contamination and the development of pressure lesion s of the gums and tongue. Furthermore, the tube is usually tolerated for on ly a short time during the weaning phase. Nasal intubation is associated wi th an increased incidence of nasal necroses and sinusitis. Tracheal intubat ion has the advantage that the dead space Is reduced, it is more comfortabl e for the patient and the weaning period is shortened, thus decreasing the duration of bed confinement. Percutaneous tracheostomy (PT) was introduced as an alternative to conventional surgical tracheostomy. It was the aim of this study to present the authors' experience with PT. Patients and methods: PT was performed under bronchoscopic control with the aid of dilators or dilatating forceps in 78 patients in a cardiological IC U (13 women, 68 men; average age 64 +/- 14 years) with heart failure (n = 3 4 [44%]), cerebral problems post-resuscitation (n = 32) [41%]), pulmonary i nfection (9 [11%]) or other conditions (n = 3 [4%]). Results: Because of contraindications PT was not done in 12 patients (15%). Percutaneous emphysema developed in one woman as a result of injury to tra cheal cartilage. There were no other complications. Two patients with throm bocytopenia were given platelet concentrates during the PT. At the end of t he period of ventilation the tracheostomy tube was removed. Spontaneous clo sure of the stoma occured within 3 to 5 days. Conclusions: PT is a minimally Invasive alternative to surgical tracheostom y. It has few complications and can be performed in a cardiological ICU.