Percutaneous tracheostomy by guidewire dilating forceps technique: is bronchoscopic guidance mandatory?

Percutaneous tracheostomy is a blind technique where-in bronchoscopy is advocated but is rarely practiced. Our study is aimed at evaluating the potential safety of this procedure when performed without bronchoscopic guidance.

This is a retrospective analysis of seventy-eight patients who underwent percutaneous tracheostomy using the Guide Wire Dilating Forceps method for prolonged periods of ventilation and/or for bronchial toileting for various underlying diseases. The procedure time and various complications were noted and compared with the historical controls from the literature.

The mean duration of the procedure was 3.09 +/- 0.49 minutes with a range of 1.5 to 14 minutes in comparison to 8.9 minutes with a range of 2 to 33 minutes as in literature where-in bronchoscopy was used. No major perioperative complications were encountered. Two patients (2.6%) had persistent peristomal oozing as an early complication when compared to that in the literature (12.5%) (p < 0.05). Twenty-seven patients were decannulated, with good tissue approximation (mean: 3.51 days).

In the absence of bronchoscopic guidance, percutaneous tracheostomy can be performed safely and speedily if simple precautions like ensuring free aspiration of air on needle insertion into trachea, bubbling of fluid placed over the hub of the cannula during ventilation and free mobility of guide wire at each step of the procedure were observed to secure the right positioning of the tracheostomy tube.