[Elective percutaneous tracheotomy in long-term ventilation in a coronary intensive care unit]

Long-term mechanical ventilation presents a problem in an intensive care unit (ICU). If done via oral intubation it brings the danger of bacterial contamination and the development of pressure lesions of the gums and tongue. Furthermore, the tube is usually tolerated for only a short time during the weaning phase. Nasal intubation is associated with an increased incidence of nasal necroses and sinusitis. Tracheal intubation has the advantage that the dead space is reduced, it is more comfortable for the patient and the weaning period is shortened, thus decreasing the duration of bed confinement. Percutaneous tracheostomy (PT) was introduced as an alternative to conventional surgical tracheostomy. It was the aim of this study to present the authors' experience with PT.

PT was performed under bronchoscopic control with the aid of dilators or dilatating forceps in 78 patients in a cardiological ICU (13 women, 68 men; average age 64 +/- 14 years) with heart failure (n = 34 [44%]), cerebral problems post-resuscitation (n = 32)[41%]), pulmonary infection (9[11%]) or other conditions (n = 3[4%]).

Because of contraindications PT was not done in 12 patients (15%). Percutaneous emphysema developed in one woman as a result of injury to tracheal cartilage. There were no other complications. Two patients with thrombocytopenia were given platelet concentrates during the PT. At the end of the period of ventilation the tracheostomy tube was removed. Spontaneous closure of the stoma occurred within 3 to 5 days.

PT is a minimally invasive alternative to surgical tracheostomy. It has few complications and can be performed in a cardiological ICU.