PERCUTANEOUS DILATATIONAL TRACHEOSTOMY IN A MEDICAL ICU

Objective: To evaluate the safety of percutaneous dilatational tracheo stomy. Design: A prospective clinical study. Setting: The intensive ca re unit of a university medical clinic. Patients: 137 critically ill p atients admitted between May 1993 and September 1996. Intervention: Pe rcutaneous dilatational tracheostomy at the bedside. Results: The medi an duration of translaryngeal intubation prior to tracheostomy was 8 d ays. Tracheostomy was carried out within 12.8 min (range 7-30 min). Ac ute complication were documented in 11.0% of the patients. There was o ne case of severe bleeding with transient asphyxia. Four patients had tracheal mucosal laceration treated conservatively. The postoperative in-hospital complication rate was 5.1%, the sole problem being stomal bleeding, Only two cases of stomal infection were documented. There wa s no procedure-related mortality. Conclusion: In the hands of the expe rienced, percutaneous dilatational tracheostomy is a safe and quick be dside procedure. It is also less expensive and incurs minimal stress f or the patient compared with the surgical method. The technique can be easily mastered by non-surgical physicians and we feel that it is the method of choice for elective tracheostomy in the majority of intensi ve care patients.