Should a percutaneous dilational tracheostomy be guided with a bronchoscope?

The aim was to evaluate the complications and practicability of percutaneous dilational tracheostomy (PDT) with and without video endoscopic guidance in critically ill patients.

In a retrospective review of patients admitted to a multidisciplinary ICU, PDT was performed under bronchoscopic control in 74 patients and without bronchoscopic control in 113 patients. Both groups were evaluated in similar technical conditions.

Complications in both groups were mostly minor. Bleeding or difficult tracheal cannulation occurred in 8 patients in each group. In patients without bronchoscopy, one major bleeding necessitated a switch to open revision, the Murphy eye was punctured (n = 2) and there was one pneumothorax. Furthermore, similar levels of cuff leaks, loss of airway and minor stoma infections were noted in both groups. All tracheostomies were performed bedside with similar manpower. Operation times were shorter in patients without bronchoscopy.

Our data about PDT in critically ill patients do not indicate any clear-cut difference in complication rates or practicability in the absence of bronchoscopic guidance when adequate skills and experience have been acquired and simple but effective precautions at each step are adopted. However, randomisation and long-term laryngotracheal followup should be considered in future studies.