Tracheostomy in critically ill patients

The authors made a retrospective analysis of results and complications of elective tracheostomies performed by percutaneous dilatational technique (PDT) as well as standard surgical procedure (ST) in critically ill patients in the ICU. The indication for tracheostomy was to facilitate long-term mechanical ventilation, to facilitate cleaning and management of the airway and to maintain upper airway patency. During a 5-year period there were 495 elective tracheostomies performed in the ICU setting, in 209 females and 286 males. From these, 408 were standard (82.4%) and 87 percutaneous dilatational tracheostomies (17.6%). Mean age of patients with tracheostomy was 63.3 years (range 17-93 years) and the mean duration of endotracheal intubation before tracheostomy was 7 days (range from 13 minutes to 21 days). During the monitored period 144 patients (29.0%) were decannulated, out of which 34 patients (23.6%) had PDT and 110 patients (76.4%) ST. A total of 265 patients (53.5%) with tracheostomy died and 86 patients (17.3%) had the tracheostomy cannule in place at the study conclusion. Perioperative complications totaled 14 (2.8%), the most serious being one cardiac arrest and death (0.4%) both in ST as well as in PDT groups. Early postoperative complications totaled 46 (9.2%). Late postoperative complications totaled 7 (1.4%). Percutaneous dilatational tracheostomy is an alternative method to standard surgical tracheostomy in critically ill patients in the ICUs. Standard surgical tracheostomy is an irreplaceable procedure in patients with complex anatomic condition or in high-risk patients. (Tab. 3, Ref. 11).