Tracheostomy in the intensive care unit: a safe alternative to the operating room

Severely injured patients frequently require endotracheal intubation, either by the nasotracheal (NT) or orotracheal (OT) route, for airway control and/or ventilatory support. If intubation is required for more than two to four weeks, an elective tracheostomy is usually indicated. Transferring these patients to the operating room is difficult, and it impairs their continued monitoring and care. Over a period of 48 months at our institution, 74 patients had tracheostomy done in the intensive care unit (ICU) by a surgical resident (PG2 level) assisted by a chief resident or attending faculty member. Local anesthesia was supplemented with intravenous sedatives, and operating room technique was used, with complete surgical instrument pack and adequate lighting. There were no deaths from the procedure. There were no complications specifically attributed to the performance of tracheostomy in the ICU, though one patient each suffered tracheitis, tracheostomy tube dislodgement, and tracheomalacia. Tracheostomy in the ICU avoids the risks of moving these patients with all their monitoring and infusion lines, and saves operating room time and charges. Trained surgical personnel using adequate instruments and lighting can safely perform a tracheostomy in the intensive care unit.