Bedside tracheostomy in the intensive care unit: A prospective randomized trial comparing open surgical tracheostomy with endoscopically guided percutaneous dilational tracheotomy

Objectives: Objectives of the study were 1) to analyze the complication inc idence and resource utilization of two methods of bedside tracheostomy and 2) to define selection criteria for bedside tracheostomy. Study Design: Pro spective randomized trial in the setting of a tertiary care center at a uni versity hospital. Methods: One hundred sixty-four consecutive intubated pat ients selected for elective tracheostomy were enrolled, One hundred patient s met selection criteria for bedside tracheostomy and were randomly assigne d to either open surgical tracheostomy (50) or endoscopically guided percut aneous dilational tracheotomy(50), The remaining 64 patients received open surgical tracheostomies in the operating room. Main outcome measures were 1 ) perioperative and postoperative complication incidence and 2) resource ut ilization. Results: Patients meeting our selection criteria for bedside tra cheostomy had a significantly reduced perioperative complication rate compa red with those who failed to meet these criteria, and subsequently underwen t tracheostomy placement in the operating room (5% vs, 20%, P less than or equal to .01). No statistically significant difference was found in the per ioperative complication incidence between the two methods of bedside trache ostomy, However, percutaneous tracheostomy placement at the bedside resulte d in a significant increase in postoperative complication incidence (16% vs . 2%, P <.05) and incurred an additional patient charge of $436 per bedside procedure. Conclusions: This investigation prospectively confirms the safe ty of bedside tracheostomy placement in properly selected patients. Complic ation incidence and resource utilization are defined for two methods of bed side tracheostomy, The results of this study confirm that open surgical tra cheostomy represents the standard of care in bedside tracheostomy placement by providing a more secure airway at a markedly reduced patient charge. Th ese findings will aid in the development of protocols and pathways for surg ical airway management in critically ill patients to maximize cost-effectiv e, high-quality care.