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Percutaneous dilatational tracheostomy: still a surgical procedure
R H Suh1, D R Margulies, M L Hopp
1Department of Surgery, Burns and Allen Research Institute, Cedars-Sinai Medical Center and the University of California at Los Angeles School of Medicine, USA.
The American Surgeon
|October 9, 1999
Summary
Percutaneous dilatational tracheostomy (PDT) is a safe bedside procedure with a 15.8% complication rate, including two perioperative deaths. This study evaluated PDT complications at a new medical center.
Area of Science:
- Medical Procedures
- Intensive Care Medicine
- Surgical Complications
Background:
- Percutaneous dilatational tracheostomy (PDT) is a cost-effective alternative to open tracheostomy (OT).
- Existing data on PDT complications are inconsistent, ranging from minor to fatal events.
- Tertiary medical centers need to evaluate PDT safety and efficacy.
Purpose of the Study:
- To prospectively identify the types and severity of complications associated with introducing PDT.
- To assess the safety profile of PDT in a tertiary medical center setting.
- To establish institutional criteria for PDT patient selection.
Main Methods:
- Prospective study of ICU patients requiring elective tracheostomy.
- PDT performed at the ICU bedside with surgeon supervision (privileged for OT).
- Data collection included demographics, procedure details, and patient outcomes (complications, length of stay, survival).
Main Results:
- PDT was performed in 95 ICU patients, averaging 13.1 minutes.
- 15 patients (15.8%) experienced 23 major/minor complications, including 2 perioperative deaths.
- 38.9% of PDT patients died during hospitalization, reflecting underlying critical illness.
Conclusions:
- PDT is a viable bedside procedure with a manageable complication rate.
- The severity of illness in patients requiring tracheostomy contributes to overall mortality.
- Continued surgeon supervision (privileged for OT) is recommended for all PDT procedures at this institution.