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Related Experiment Videos

Extended indications for percutaneous tracheostomy.

Alon Ben Nun1, Eduard Altman, Lael Anson Best

  • 1a_ben_nun@rambam.health.gov.il

The Annals of Thoracic Surgery
|September 27, 2005
PubMed
Summary

Percutaneous tracheostomy is safe and effective even in patients with contraindications like obesity or coagulopathy. This procedure shows low complication rates, similar to those without adverse conditions, supporting its broader use.

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Area of Science:

  • Critical Care Medicine
  • Surgical Procedures
  • Airway Management

Background:

  • Percutaneous tracheostomy is a common ICU procedure.
  • Historically, adverse conditions were considered contraindications.
  • Recent evidence suggests feasibility in high-risk patients.

Purpose of the Study:

  • To evaluate the safety and efficacy of percutaneous tracheostomy in patients with commonly cited contraindications.
  • To compare complication rates in patients with and without adverse conditions.

Main Methods:

  • 157 percutaneous tracheostomy procedures were performed on 154 critically ill adults.
  • Procedures utilized the Griggs technique with a Portex set at the bedside.
  • Data collected included anatomical conditions, coagulopathy, anticoagulation, and complications.

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Main Results:

  • Overall, 5 of 157 procedures (3.2%) resulted in complications.
  • Patients with normal anatomy and coagulation had one bleeding and one cellulitis case.
  • Patients with adverse conditions experienced one moderate bleeding and two minor bleeding events.

Conclusions:

  • Percutaneous tracheostomy demonstrated a low complication rate in patients with adverse conditions, comparable to those without.
  • Conditions like short/fat neck, limited neck extension, enlarged thyroid isthmus, previous tracheostomy, or coagulopathy should not preclude its use.
  • The study supports expanding the indications for percutaneous tracheostomy in critically ill patients.