Can intensive care physicians safely perform percutaneous dilational tracheostomy? An analysis of 207 cases

Background: Percutaneous tracheostomy has largely replaced surgical tracheostomy in the intensive care unit setting. Although it seems logical that surgeons continue to do tracheostomies, anesthesiologists and intensive care specialists are familiar with airway control and guide wire techniques and could replace surgeons in the performance of PDT. Objectives: To assess the safety and effectiveness of bedside PDT in the ICU. Methods: We conducted a retrospective chart review of 207 patents in the ICU who underwent PDT by an intensive care physician. Results: Subcutaneous emphysema without pneumothorax occurred in one patent. Four patients underwent surgical revision following PDT. Early bleeding (during the first 48 hours following the procedure) was the indication in two patients and late bleeding, on the 10th post-PDT day, in one. In one case PDT was converted to surgical tracheostomy due to inadvertent early decannulation. There was one death directly related to the procedure, due to an unrecognized paratracheal insertion of the tracheostomy tube followed by mechanical ventilation, which led to bilateral pneumothorax, pneumomediastinum and cardio-circulatory collapse. No infectious complications were seen at the stoma site or surrounding tissues. Conclusions: PDT by intensive care physicians appears to be safe and should be included in the curriculum of intensive care residency.