J Neurocrit Care.  2018 Jun;11(1):32-38. 10.18700/jnc.170031.

Safety and Feasibility of Percutaneous Dilatational Tracheostomy in the Neurocritical Care Unit

• Lee DH
• Jeong JH

• KMID: 2426211
• DOI: http://doi.org/10.18700/jnc.170031

Abstract

BACKGROUND
Percutaneous dilatational tracheostomy (PDT) is one of the most commonly performed procedures on critically ill patients, and many studies have shown the safety and feasibility of PDT, but there is limited data of PDT in neurocritical care units. We described our experience on PDT performed by neurointensivist.
METHODS
The PDTs were performed by a neurointensivist at the bedside using the Griggs guide wire dilating forceps technique. To confirm a secure puncture site, the PDT was done under fiberoptic bronchoscopic guidance. From September 2015 to August 2017, procedural data were prospectively collected, and the patients' demographic and clinical characteristics were retrospectively reviewed. We analyzed immediate complications of PDT as the primary outcome.
RESULTS
The PDTs were performed for 46 patients; and the mean age was 65.9 years, 26 (56.5%) were male, and the mean acute physiology and chronic health evaluation II score was 20.5. Overall, the procedural success rate was 100%, and the mean procedural time was 19.7±9.3 minutes. Periprocedural complications occurred in 13 (28.3%) patients; with 10 having minor bleeding and three having a tracheal ring fracture. There were no serious periprocedural complications of PDT.
CONCLUSION
From our experience, the PDT in the neurocritical care unit was safe and feasible and was implemented without serious complications.

Keyword

Tracheostomy; Safety; Critical care; Hemorrhage

MeSH Terms

APACHE
Critical Care
Critical Illness
Hemorrhage
Humans
Male
Prospective Studies
Punctures
Retrospective Studies
Surgical Instruments
Tracheostomy*