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Outcome of bedside percutaneous tracheostomy with bronchoscopic guidance
R Hinerman1, F Alvarez, C A Keller
1Division of Pulmonary, Critical Care, and Occupational Medicine, St Louis University Medical School, St Louis University Hospital, MO 63110, USA. kellerc@slu.edu
Objective:
To determine the morbidity and mortality of percutaneous dilational tracheostomy with bronchoscopic guidance when performed by medical intensivists.
Design:
A retrospective analysis.
Setting:
A tertiary care university hospital.
Patients:
Fifty consecutive patients who underwent percutaneous dilational tracheostomy for prolonged mechanical ventilation.
Intervention:
Bedside percutaneous dilational tracheostomy with bronchoscopic guidance.
Results:
Seventeen women and 33 men with a mean age of 62 +/- 17 years. Operative mortality was 0 with four (8%) operative complications. Complications included one posterior tracheal abrasion, one anterior tracheal laceration, one episode of endobronchial hemorrhage requiring bronchoscopy, and one pneumothorax. Thirty-day mortality was 28% and overall mortality was 40%. All deaths were related to the patients' underlying disease.
Conclusions:
Percutaneous dilational tracheostomy with bronchoscopic guidance is a safe procedure when performed by experienced medical intensive care personnel in tertiary care institutions. Bronchoscopy helps to reduce the risk of major complications and aids in the management of minor complications.