Percutaneous tracheostomy in critically ill patients: 24 months experience at a tertiary care hospital in United Arab Emirates

Abstract

OBJECTIVE:We assessed the safety and complications related to percutaneous tracheostomy (PCT) without bronchoscopic guidance in our intensive care unit (ICU).METHODS:The prospective data over a period of 24 months were collected for patients who underwent PCT. Major, minor and long-term complications were recorded. The parameters recorded were: age, gender, Glasgow Coma Scale (GCS) score on the day of tracheostomy, acute physiology and chronic health evaluation II (APACHE) score, and predicted mortality based on score on admission and on the day of procedure, number of days on ventilator before and after the procedure, total number of days in the hospital before the final outcome, number of successful decannulations and mortality. The patients were stratified in two groups of survivors and nonsurvivors.RESULTS:A total of 117 patients underwent PCT. Overall mean GCS and APACHE-II scores before PCT were 7 ± 3 and 16 ± 5, respectively. The only significant difference was APACHE-II score and the predicted mortality based on APACHE-II score on the day of PCT, which was higher amongst the nonsurvivors (P = 0.008 and P = 0.006). All 57 (49%) survivors were successfully decannulated with mean post tracheostomy days of 24 ± 15. The major complication observed was three episodes of major bleeding. Only six patients had an episode of desaturation during the procedure and there were three episode of accidental puncturing of endotracheal (ET) tube pressure cuff. During subsequent follow-up in hospital, six patients developed stomal cellulitis.CONCLUSIONS:PCT without bronchoscopic guidance can be performed safely by carefully selecting patients and having an experienced team High APACHE score on the day of procedure may lead to poor outcome.

A technical modification for percutaneous tracheostomy: prospective case series study on one hundred patients

“…Studies have shown that bronchoscopy can cause hypoventilation that leads hypercarbia and respiratory acidosis during percutaneous tracheostomy [ 12 , 35 , 36 ]. Nonetheless, percutaneous tracheostomy without bronchoscopic guidance remains a controversial issue [ 4 , 12 , 19 , 29 , 31 , 34 , 37 - 40 ].…”

“…Investigators who forgo bronchoscopy during percutaneous tracheostomy usually implement additional measures to compensate for the lack of intraluminal visualization of the trachea [ 12 , 18 , 37 - 39 , 41 - 44 ]. For example, dissection of the subcutaneous tissue down to the pre-tracheal fascia prior to tracheal puncture, palpation of the trachea through the incision during endotracheal tube positioning and tracheal puncture, verification of free mobility of the guidewire throughout the procedure, and capnography assessed at the puncture site [ 12 , 18 , 37 - 39 , 41 - 44 ]. Additionally, ultrasound has become an increasingly used adjunct to percutaneous tracheostomy when bronchoscopy is not available, particularly in obese patients.…”

Percutaneous Tracheostomy By Physician Intensivists

“…Ahmed et al shared an experience of 117 cases for the first time from United Arab Emirates. 18 They also concluded that percutaneous tracheostomy without bronchoscopy guidance could be performed safely by carefully selecting the patients and having an experienced team.…”

A Rare Early Complication of Tracheostomy

“…1 These patients can have multiple complications after the closure of tracheostomy. 1 These patients can have multiple complications after the closure of tracheostomy.…”