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Few Complications With Bedside Tracheotomy

Tue, 01/21/2014 - 10:14am
Ed Susman

Bedside percutaneous tracheotomy can be done in critically ill patients with a low risk of morbidity in the community hospital setting, researchers said here.

Among 41 intensive care unit (ICU) patients who underwent the procedure, there was a 2 percent complication rate and no procedure-related deaths, reported Peter Abdelmessieh, DO, from Lenox Hill Hospital in New York City, and colleagues.

The complication was an excessive bleed that resolved without formal exploration, they explained in a poster presentation at the annual meeting of the Society of Critical Care Medicine (SCCM).

"Percutaneous dilatational tracheotomy (PDT) has become one of the most widely used procedures in ICUs worldwide offering the benefit of both being cost-effective and an overall safer technique for critically ill patients," the group wrote. "Although PDT have been the preferred technique in our ICU, as well as at many other institutions, it has yet to be accepted by the surgical community."

Abdelmessieh and colleagues retrospectively collected charts of 41 patients who underwent PDT at their hospital during the previous year. The chart information was reviewed by researchers who had no role in the procedures. No patients were excluded from the analysis for any of the cases reviewed for the study.

Abdelmessieh explained that PDT is performed under general sedation, and the surgeons at Lenox Hill use a Ciaglia Blue Rhino Kit.

Under bronchoscopic visualization, the endotracheal tube is withdrawn to the level of the cricothyroid membrane and a small incision is made in the midline between the first and second, or second and third, tracheal rings. The tube is inserted in the trachea over a guidewire, using a series of dilators in the modified Seldinger technique, and is then sutured in place. The endotracheal tube is removed and the ventilator is connected to the tracheotomy tube. Bronchoscopy through the endotracheal tube confirms placement.

The average age of the patients in the study was 75.5 years and the majority (25) were men. Patients were intubated for an average of 11.6 days before the PDT was performed.

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