Acute Crit Care.  2022 Feb;37(1):101-107. 10.4266/acc.2021.00906.

The feasibility and safety of percutaneous dilatational tracheostomy without endotracheal guidance in the intensive care unit

• Kim JE
• Lee DH

• KMID: 2527912
• DOI: http://doi.org/10.4266/acc.2021.00906

Abstract

Background
Percutaneous dilatational tracheostomy (PDT) is a common procedure in intensive care units (ICUs). Although it is thought to be safe and easily performed at the bedside, PDT usually requires endotracheal guidance, such as bronchoscopy. Here, we assessed the clinical outcomes and safety of PDT conducted without endotracheal guidance.
Methods
In the ICU and coronary ICU at a tertiary hospital, PDT was routinely performed without endotracheal guidance by a single medical intensivist using the Griggs technique PDT kit (Portex Percutaneous Tracheostomy Kit). We retrospectively reviewed the electronic medical records of patients who underwent PDT without endotracheal guidance.
Results
From January 1 to December 31, 2018, 78 patients underwent PDT without endotracheal guidance in the ICU and coronary ICU. The mean age of these subjects was 71.9±11.5 years, and 29 (37.2%) were female. The mean Acute Physiology And Chronic Health Evaluation (APACHE) II score at 24 hours after admission was 25.9±5.8. Fifty patients (64.1%) were on mechanical ventilation during PDT. Failure of the initial PDT attempt occurred in 4 patients (5.1%). In two of them, PDT was aborted and converted to surgical tracheostomy; in the other two patients, PDT was reattempted after endotracheal reintubation, with success. Minor bleeding at the tracheostomy site requiring gauze changes was observed in five patients (6.4%). There were no airway problems requiring therapeutic interventions or procedure-related sequelae.
Conclusions
PDT without endotracheal guidance can be considered safe and feasible.

Keyword

airway management; intensive care units; tracheostomy

Reference

1. Freeman BD, Isabella K, Lin N, Buchman TG. A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest. 2000; 118:1412–8.

2. Brambrink A. Percutaneous dilatation tracheostomy: which technique is the best for the critically ill patient, and how can we gather further scientific evidence? Crit Care. 2004; 8:319–21.

3. Cooper RM. Use and safety of percutaneous tracheostomy in intensive care: report of a postal survey of ICU practice. Anaesthesia. 1998; 53:1209–12.

4. Hyde GA, Savage SA, Zarzaur BL, Hart-Hyde JE, Schaefer CB, Croce MA, et al. Early tracheostomy in trauma patients saves time and money. Injury. 2015; 46:110–4.

5. Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA. 2010; 303:1483–9.

6. Flaatten H, Gjerde S, Heimdal JH, Aardal S. The effect of tracheostomy on outcome in intensive care unit patients. Acta Anaesthesiol Scand. 2006; 50:92–8.

7. Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy: a new simple bedside procedure; preliminary report. Chest. 1985; 87:715–9.

8. Hinerman R, Alvarez F, Keller CA. Outcome of bedside percutaneous tracheostomy with bronchoscopic guidance. Intensive Care Med. 2000; 26:1850–6.

9. Gadkaree SK, Schwartz D, Gerold K, Kim Y. Use of bronchoscopy in percutaneous dilational tracheostomy. JAMA Otolaryngol Head Neck Surg. 2016; 142:143–9.

10. Rudas M, Seppelt I, Herkes R, Hislop R, Rajbhandari D, Weisbrodt L. Traditional landmark versus ultrasound guided tracheal puncture during percutaneous dilatational tracheostomy in adult intensive care patients: a randomised controlled trial. Crit Care. 2014; 18:514.

11. Gobatto AL, Besen BA, Cestari M, Pelosi P, Malbouisson LM. Ultrasound-guided percutaneous dilational tracheostomy: a systematic review of randomized controlled trials and meta-analysis. J Intensive Care Med. 2020; 35:445–52.

12. Baek JK, Lee JS, Kang M, Choi NJ, Hong SK. Feasibility of percutaneous dilatational tracheostomy with a light source in the surgical intensive care unit. Acute Crit Care. 2018; 33:89–94.

13. Jackson LS, Davis JW, Kaups KL, Sue LP, Wolfe MM, Bilello JF, et al. Percutaneous tracheostomy: to bronch or not to bronch--that is the question. J Trauma. 2011; 71:1553–6.

14. Pattnaik SK, Ray B, Sinha S. Griggs percutaneous tracheostomy without bronchoscopic guidance is a safe method: a case series of 300 patients in a tertiary care intensive care unit. Indian J Crit Care Med. 2014; 18:778–82.

15. Ciaglia P. Technique, complications, and improvements in percutaneous dilatational tracheostomy. Chest. 1999; 115:1229–30.

16. Mehta C, Mehta Y. Percutaneous tracheostomy. Ann Card Anaesth. 2017; 20(Suppl 1):S19–25.

17. Fernandez-Bussy S, Mahajan B, Folch E, Caviedes I, Guerrero J, Majid A. Tracheostomy tube placement: early and late complications. J Bronchology Interv Pulmonol. 2015; 22:357–64.