[Tracheostomy in the intensive care unit]

During the last 22 months, a total number of 85 tracheostomies have been performed in our ICU, 40 of which have been surgical, and 45 percutaneous to patients under mechanical ventilation. This period has coincided with the learning process of the technique of percutaneous tracheostomy by our staff. The choice of the type of tracheostomy was not taken at random, but guided by clinical criteria. Our results confirm a lower rate of infection of the estoma in percutaneous tracheostomies than in surgical ones (5 percutaneous and 29 surgical, p < 0.001). The most serious complication was a tracheal perforation in a percutaneous tracheostomy. 17 of the 85 patients died in ICU, and 33 of the 68 patients who were discharged, survived the hospital, 27 of whom left with a closed tracheostomy. The other 6 permanent tracheostomies had been performed surgically and corresponded to 4 patients with worsening EPOC, one neurological patient and another patient suffering from anoxic encephalopathy. No percutaneous tracheostomy was left as permanent. The patients who benefitted especially from the tracheostomy presented the following characteristics: acute respiratory insufficiency with prolonged intubation, neurological patients, and worsening EPOC. The tracheostomy in persistent vegetative status allowed their moving to more suitable areas. Our study proves the existence of a learning curve in the practice of percutaneous tracheostomy. This aspect should be taken into account by other groups who are interested in including this technique in their services.