Percutaneous Tracheostomy under Bronchoscopic Visualization Does Not Affect Short-Term or Long-Term Complications.

Area of Science:

• Critical Care Medicine
• Surgical Procedures
• Trauma Surgery

Background:

• Percutaneous tracheostomy (PT) is a common bedside procedure for critically ill patients.
• Bronchoscopic guidance during PT is advocated by some to minimize complications.
• Evidence comparing complication rates with and without bronchoscopy in trauma patients is limited.

Purpose of the Study:

• To evaluate the complication rates of PT in trauma patients performed with and without bronchoscopic guidance.
• To determine if bronchoscopic assistance impacts the safety and efficacy of PT in this population.

Main Methods:

• Retrospective review of trauma registry data from a Level I Trauma Center.
• Analysis of 649 critically ill trauma patients undergoing modified PT between January 2007 and April 2016.
• Comparison of complication rates between patients who received bronchoscopic guidance (n=289) and those who did not (n=360).

Main Results:

• No statistically significant differences in any complication type were observed between the bronchoscopy-assisted and non-assisted PT groups.
• A total of 649 patients underwent PT, with 289 utilizing bronchoscopy and 360 not.
• Complication rates were comparable regardless of the use of a bronchoscope.

Conclusions:

• The addition of bronchoscopy during PT offers theoretical benefits but did not demonstrate a statistically significant reduction in complications in this trauma cohort.
• The decision to use a bronchoscope during percutaneous tracheostomy should be at the discretion of the performing physician based on individual patient factors and clinical judgment.