Open bedside tracheotomy in the intensive care unit

Area of Science:

• Surgical Procedures
• Critical Care Medicine
• Health Economics

Background:

• Tracheotomy is a common surgical procedure for airway management.
• Traditional open tracheotomy is often performed in the operating room, incurring higher costs and resource utilization.
• Percutaneous tracheotomy offers an alternative but may have specific indications and associated costs.

Purpose of the Study:

• To evaluate the efficiency, safety, and cost-effectiveness of open bedside tracheotomy.
• To compare open bedside tracheotomy with operating room and percutaneous techniques.

Main Methods:

• Retrospective review of over 200 open bedside tracheotomies performed between 1995 and 1998.
• Minimal staffing required: attending/senior resident, junior resident/intern, and respiratory therapist.
• Procedure duration averaged 15-25 minutes; patients followed for 30 days post-surgery.

Main Results:

• Major complication rate (hemorrhage, myocardial infarction) <1%.
• Minor complication rate (site bleeding) was 4%.
• Overall 30-day mortality was 8% (unrelated to tracheotomy); procedure cost was $233, significantly less than OR ($3000+) or percutaneous ($1000+).

Conclusions:

• Open bedside tracheotomy is an efficient and economical alternative to operating room procedures.
• The safety profile is comparable to percutaneous tracheotomy.
• This technique offers significant cost savings without compromising patient safety.