Should a percutaneous dilational tracheostomy be guided with a bronchoscope?

Area of Science:

• Critical Care Medicine
• Surgical Procedures
• Respiratory Care

Background:

• Percutaneous dilational tracheostomy (PDT) is a common procedure in intensive care units.
• The use of video endoscopic guidance during PDT is debated regarding its impact on safety and feasibility.

Purpose of the Study:

• To compare the complications and practicability of PDT with and without video endoscopic guidance in critically ill patients.

Main Methods:

• Retrospective review of 187 critically ill patients undergoing PDT.
• Comparison of outcomes between patients who had PDT with bronchoscopic control (n=74) and without (n=113).

Main Results:

• Both groups experienced mostly minor complications; bleeding or difficult cannulation occurred in 8 patients each.
• One major bleeding event requiring open revision, two Murphy eye punctures, and one pneumothorax occurred in the non-bronchoscopic group.
• Similar rates of cuff leaks, airway loss, and minor infections were observed; procedure times were shorter without bronchoscopy.

Conclusions:

• PDT in critically ill patients demonstrates comparable complication rates and practicability without bronchoscopic guidance, provided adequate skills and precautions are employed.
• Future studies should consider randomization and long-term laryngotracheal follow-up to further elucidate outcomes.