Percutaneous Dilatational Tracheostomy with Bronchoscopic Guidance in Intensive Care Unit

Abstract

Objective: Tracheostomy is one of the most common invasive procedures in emergency rooms, intensive care units, and the bedside. In the intensive care unit, tracheostomies are most often used for prolonged mechanical ventilation, to preserve the airway and to permit pulmonary drainage. Percutaneous dilatational tracheostomy (PDT) was performed using the Seldinger method. To minimize tracheal posterior wall damage, bronchoscopy guidance was used to determine the proper spot for tracheal puncture, guide real-time needle entry into the trachea, and confirm cannula position. This study introduces bronchoscopy-guided modified mini-surgical PDT and aims to evaluate early complications with 388 case analyses. Methods: Demographic data from patients, intensive care indications, APACHE-2 scores, duration of stay on the ventilator before tracheostomy, total duration of stay, and early complications during tracheostomy were recorded by analyzing patient files. All data from PDT patients between 2018 and 2022 were retrospectively reviewed. Results: Of 492 tracheostomies, 388 (78.8%) were opened percutaneously. The mean and median duration of stay on the ventilator before tracheostomy were 12.95 and 12 days, respectively. The mean and median duration lengths of stay were 29.43 and 14.355 days, respectively. The most common indication for tracheostomy was chronic obstructive pulmonary disease in 70 (18%), patients. Complications related to tracheostomy were observed in 19 patients, representing a complication rate of 4.9%. Of these, 2 (0.5%) bleeds stopped with cautery, and 2 (0.5%) bronchospasms occurred during the procedure. Conclusion: Percutaneous dilatational tracheostomy is a simple and safe tracheostomy method. Its use with bronchoscopy can facilitate the procedure and minimize the complications that may occur.