Percutaneous tracheostomy boundaries revisited

As percutaneous tracheostomies (PCTs) which have various contra-indications (CI) are increasingly performed by non-otolaryngologists, the otolaryngologist's role is reviewed. The ability of tracheal palpation was the single criteria to perform PCT.

Retrospective chart review.

A retrospective study analyzing adult PCTs performed by otolaryngologists at 2011-2012 were reviewed. All PCTs were performed using the Ciaglia blue-rhino-tracheostomy kit and Shiley's tracheostomy cannulas. Most procedures were performed with the same anesthesiologist.

A total of 60 PCTs were identified with subject ages 18-91. None were converted to open tracheostomy. No bronchoscopic guidance was used. PCT was performed for the following CI: two bleeding disorder, four goiters, four cervical rigidity (surgical, traumatical and constitutional), five emergent tracheostomies, one head and neck cancer and nine short necks. Complications recorded were one wound bleeding and one pneumomediastinum both controlled locally. Pertinent anatomy revealed that the intubation tube was withdrawn to the level of 14 cm and 16 cm from incisor level in women and men respectively.

PCT is a safe procedure. When performed by an otolaryngologist, even the relative CI can be overcome. Tracheal palpation and experienced anesthesiologist are mandatory for the procedure's success. The otolaryngologists' advantage is a better anatomical understanding with the ability to convert the procedure to a formal tracheostomy as needed and avoidance of hypercarbia due to a bronchoscope use. Otolaryngologists should be the first line providers in any tracheostomy.