Percutaneous Tracheostomy under Bronchoscopic Visualization Does Not Affect Short-Term or Long-Term Complications

Abstract

Percutaneous tracheostomy is a safe and effective bedside procedure. Some advocate the use of bronchoscopy during the procedure to reduce the rate of complications. We evaluated our complication rate in trauma patients undergoing percutaneous tracheostomy with and without bronchoscopic guidance to ascertain if there was a difference in the rate of complications. A retrospective review of all tracheostomies performed in critically ill trauma patients was performed using the trauma registry from an urban, Level I Trauma Center. Bronchoscopy assistance was used based on surgeon preference. Standard statistical methodology was used to determine if there was a difference in complication rates for procedures performed with and without the bronchoscope. From January 2007, to April 2016, 649 patients underwent modified percuteaneous tracheostomy; 289 with the aid of a bronchoscope and 360 without. There were no statistically significant differences in any type of complication regardless of utilization of a bronchoscope. The addition of bronchoscopy provides several theoretical benefits when performing percutaneous tracheostomy. Our findings, however, do not demonstrate a statistically significant difference in complications between procedures performed with and without a bronchoscope. Use of the bronchoscope should, therefore, be left to the discretion of the performing physician.

The role of routine FIBERoptic bronchoscopy monitoring during percutaneous dilatational TRACHeostomy (FIBERTRACH). A study protocol for a randomized, controlled clinical trial

“…For others [10], these studies are limited and unclear whether visualization of the interior of the airway is a necessary component of the procedure. In two comparative retrospective studies [10,11], the addition of bronchoscopy was not accompanied by a signi cant difference in complications between procedures performed with and without a bronchoscope. In a retrospective analysis [12] involving trauma patients, the use of beroptic bronchoscopy (FB) when performing PDT was not routinely required but might be used as an important adjunct in selected patients.…”

“…In the earlier studies [17][18][19] it was found that bronchoscopic guidance reduces the risk of complications and is safe and cost effective, but the recent comparative studies (although retrospective) have suggested that PDT can be safely performed without bronchoscopic guidance without any increase in complications and it is not mandatory to do bronchoscopy guided PDT [10][11][12][13]. Some authors have even hypothesized discarding the use of bronchoscopy for this procedure in order to potentially decrease its cost and increase its e ciency with similar outcomes compared with bronchoscopy-assisted PDT [10].…”

“…The duration of the procedure in all four patients lasted between 10 and 15 min and the authors stated that the use of endoscopic guidance prevented damage to the posterior tracheal wall, and helped identifying the puncture site thanks to transillumination. Currently, the "routine" use of endoscopic guidance as part of percutaneous tracheostomy is controversial [10][11][12][13] and guidelines cannot establish recommendation level [14][15][16].…”

Development of a comprehensive Percutaneous Dilatational Tracheostomy process model for procedural training: A Delphi‐based experts consensus

“…Finally, the research team decided to include both activities before and after the puncture with conditional status, leaving the operator the choice to perform it or not, and when to perform it. It has been suggested that direct tracheal visualization and adequate dissection allows one to reduce both short‐term and long‐term complications 38 . On the other hand, a retrospective study showed that transverse incision, compared to cephalo‐caudal incision, resulted in less bleeding rates and tracheostomy site ulcers 39 …”

The role of routine FIBERoptic bronchoscopy monitoring during percutaneous dilatational TRACHeostomy (FIBERTRACH): a study protocol for a randomized, controlled clinical trial

“…For others [ 10 ], these studies are limited and unclear whether visualization of the interior of the airway is a necessary component of the procedure. In two comparative retrospective studies [ 10 , 11 ], the addition of bronchoscopy was not accompanied by a significant difference in complications between procedures performed with and without a bronchoscope. In a retrospective analysis [ 12 ] involving trauma patients, the use of fiberoptic bronchoscopy (FB) when performing PDT was not routinely required but might be used as an important adjunct in selected patients.…”