Outcomes and complications of bronchoscopy-guided percutaneous dilatational tracheostomy

Background: Percutaneous tracheostomy (PT) is one of the most frequently performed procedures in Intensive Care Unit (ICU). As many as 10% of patients requiring at least 3 days of mechanical ventilation will receive a tracheostomy. Some of the complications can be severe and can be prevented with bronchoscopic-assistance. Aim: To investigate the outcome and complications of bronchoscopy-guided PT. Material and methods: 59 patients was prospectively included from March-November/2010. Demographic data, time of procedure and complications were studied. Patient9s heart rate, blood pressure and continuous pulse oximetry were monitored. All PT were performed under bronchoscopic control at the patient9s bedside in the ICU by an medical intensivist and a pulmonologist. Statistical software Sigma-Stat 3.5 was used. Results: 54% of patients: male. Patient mean age: 60. Mean body mass index: 25.2 (Standar Error Mean-SEM 0.5). Mean APACHE index: 20.1. SAPS: 44.5. The reason for admission at ICU was due to medical conditions (70%) and surgical/polytraumatism (30%). Indication for PT: coma (47%), intubation weaning failure (34%), neuromuscular failure (9.4%) and prolongued endotracheal intubation (9,4%). Mean duration of PT: 3.5 mn. Main complications: O 2 desaturation Conclusions: PT is a safe technique. The use of bronchocospy reduces duration of procedure, decreases morbidity and can identify complications missed by a “blind” approach.