Percutaneous dilatational tracheostomy in a medical ICU

Abstract

Objective: To evaluate the safety of percutaneous dilatational tracheostomy. Design: A prospective clinical study. Setting: The intensive care unit of a university medical clinic. Patients: 137 critically ill patients admitted between May 1993 and September 1996. Intervention: Percutaneous dilatational tracheostomy at the bedside. Results: The median duration of translaryngeal intubation prior to tracheostomy was 8 days. Tracheostomy was carried out within 12.8 min (range 7-30 min). Acute complications were documented in 11.0% of the patients. There was one 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 was no procedure-related mortality. Conclusion: In the hands of the experienced, percutaneous dilatational tracheostomy is a safe and quick bedside procedure. It is also less expensive and incurs minimal stress for 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 intensive care patients.