Comparison Of Percutaneous Tracheostomy Process In General Intensive Care Units With Or Without Fiberoptic Bronchocopy Guidance

Abstract

Objective: Percutaneous dilatational tracheostomy (PDT) is a routine procedure in the intensive care unit. PDT can be performed under the guidance of fiberoptic bronchoscopy (FOB), that it increases safety and causes less complications and tissue damage. The aim of this study was to determine whether the FOB-guided PDT decreases the complication rate and improves safety. Method: PDT cases performed with or without the guidance of FOB by Griggs method between January 2017 and January 2018 were evaluated retrospectively. Information about the age, gender, hospitalization in the intensive care unit and PDT indications, the time (days) until the opening of the tracheostomy and total procedure time, mortality were obtained from patients' files. Complications observed in the first 24 hours of later were evaluated as early and late complications. Minor bleeding (< 10 mL), hypotension, arrhythmia, hypercapnia, hypoxia were considered as minor complications. Major hemorrhage, pneumothorax, hemothorax, false passage, subcutaneous emphysema were defined as major complications. Results: A total of 103 patients were included in the study. PDT procedure was performed with (n=44: 42.7%) and without (n=59: 57.3%) the guidance of FOB. During the procedure, SaO₂ values were found as 75% (40%,100%) and 98% (93%, 100%) in PDT procedures performed with and without the aid of FOB, respectively. The mean total duration PDT procedure performed with and without the guidance of FOB was 25.2±6 min, and 20±6 min, respectively. Fourteen patients (31.8%) developed early complications and 6 patients (13%) major complications in non-FOB group. The rate of early complications in the FOB-PDT group was 13.5% (8 patients). One patient (1.7%) developed major bleeding requiring surgical intervention. Tracheoesophageal fistula was observed in one patient (1.7%) 270 days after tracheostomy in the FOB-PDT group. Conclusion:We think that it is safer to perform PDT with the aid of FOB. Although the duration of FOB-guided PDT procedure was longer, we found that the complications of the procedure were reduced.