Bedside Tracheostomy: Our Experience in a Tertiary Care Hospital

Abstract

Tracheostomy is the creation of a stoma at the surface of skin, which leads into trachea. In the critically ill patients, it is one of the most frequently done procedure especially in intensive care unit (ICU) for those requiring prolonged mechanical ventilation. About 24% of all patients in ICU need tracheostomy (Esteban et al. in Am J Respir Crit Care Med 161:1450–1458, 2000). Historically it had a high complication rate and so many authors suggested that it should be done only in operating room (Dayal and Masri in Laryngoscope 96:5862, 1986). A standardized procedure to reduce complications was described by Jackson (Laryngoscope 19:285–290, 1909). The aim of the study is to observe and analyze the outcome of bedside open tracheostomy, in relation to its safety, complications and simplicity. Study consists of 200 patients who underwent bedside tracheostomies in a tertiary care center from 2014 to 2017 in medical/surgical/paediatric ICU’s. All the procedures followed a standard protocol. In all the surgeries, two E.N.T. surgeons were scrubbed and did the procedure, assisted by two ICU nurses. One anesthetist who administered sedation and monitored the patient. If coagulation disturbances were present in elective case then they were corrected prior to the procedure. We all want the latest, safest, simplest and cheapest available technique in medical practice. Bedside tracheostomy is one such procedure. It is better than tracheostomy in operating room for patients who need prolonged mechanical ventilation in ICU as it eliminates the need of patient transport to OR and its associated complications and also minimizing cost. Training programs need to be provided to the assisting staff for better procedural outcome.

Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation

“…Roughly 75% of the patients were younger than 2 years. A more recent review of bedside tracheostomy [40] included 20 children in a series of 200 patients, but outcomes specific to children were not reported.…”

Creation of an Open Bedside Tracheostomy Program at a Community Hospital With a Single Surgeon

“… 6 In the study by Sinha et al, 2 Otolaryngologists, 2 ICU nurses, and 1 anesthetist were used in their OBT procedures. 4 In another study, all OBTs were performed by thoracic surgeons. 15 ICU RT are also present and have been rigorously trained and familiar with the nuances of the procedure.…”

“…A bedside tracheotomy cart consisted of a headlight, electrosurgical unit, tracheotomy tray, surgical instruments, drapes, gowns, and tracheotomy tubes used in the OR 6 . In the study by Sinha et al, 2 Otolaryngologists, 2 ICU nurses, and 1 anesthetist were used in their OBT procedures 4 . In another study, all OBTs were performed by thoracic surgeons 15 .…”

“… 1 Up to one‐third of ICU patients require mechanical ventilation, which accounts for a disproportionate amount of ICU costs in addition to increasing the risk of nosocomial infections. 2 , 3 , 4 Tracheostomy is a common procedure warranted in patients requiring prolonged mechanical ventilation. 5 Indications for tracheostomy include prevention of complications related to lengthy translaryngeal intubation, facilitation of weaning from mechanical ventilation, improving oral hygiene, pulmonary toilet, and patient comfort.…”

“…Modern medical advancements have led to the ability to sustain critically ill patients and increased the need for tracheotomy in intensive care unit (ICU) patients 1 . Up to one‐third of ICU patients require mechanical ventilation, which accounts for a disproportionate amount of ICU costs in addition to increasing the risk of nosocomial infections 2‐4 . Tracheostomy is a common procedure warranted in patients requiring prolonged mechanical ventilation 5 .…”