[Percutaneous puncture tracheostomy in neurosurgical intensive care patients]

In critical care patients requiring prolonged mechanical ventilation, tracheostomy is necessary. Alternatively to the standard surgical method, a percutaneous dilatational technique is available. From September 1993 to October 1994 38 critically ill neurosurgical patients underwent tracheostomy using the minimal invasive puncture method. The patients were aged between 20 and 92 years. The average duration of the tracheostomy was 7.5 [4-15] minutes and was performed bed sided at the ICU. The tracheostomy was controlled endoscopically through the naso- or orotracheal tube. A 8 mm cannula was inserted in each case. One patient died during the procedure of sudden fulminant pulmonary artery embolism. One procedure had to be interrupted because of cardiac failure. In this patient the tracheostomy was performed the day after under optimized conditions. There was no peri- or postoperative bleeding, no pneumothorax, no misplacement of the cannula. An infection of the stoma site was not noticed. The decannulation did not cause any complications (16 cases). The stoma was closed within a few days, only a small scar remained. The bed side procedure of percutaneous dilatational tracheostomy is a safe and quick technique. There is no need to disconnect the patient from intensive monitoring for means of transportation to the surgery room. Thus we find it the method of choice for critically ill neurosurgical patients.