J Neurointensive Care.  2019 Oct;2(2):64-69. 10.32587/jnic.2019.00213.

Safety and Feasibility of Percutaneous Dilatational Tracheostomy Performed by a Neurointensivist Compared with Conventional Surgical Tracheostomy in Neurosurgery Intensive Care Unit

• Kwon J
• Kim YO
• Ryu JA

• KMID: 2555023
• DOI: http://doi.org/10.32587/jnic.2019.00213

Abstract

Objective
To evaluate safety and feasibility of percutaneous dilatational tracheostomy (PDT) performed by a neurointensivist compared with conventional surgical tracheostomy (CST) in neurosurgery patients and neurocritically ill patients.
Methods
This was a retrospective and observational study of adult patients who underwent tracheostomy in neurosurgical intensive care unit (ICU) from January 2015 to December 2017. The primary endpoint was procedure-induced complications. Secondary endpoints were initial success of tracheostomy and procedure time.
Results
A total of 118 patients underwent tracheostomy during the study period. Elective surgery of brain tumor (33.1%) and intracranial hemorrhage (20.3%) were the most common reasons for ICU admission. Prolonged intubation (42.4%) and airway protection or prevent risk of aspiration (25.4%) were the most common reasons for tracheostomy. There was no significant difference in initial success rate of tracheostomy between the two groups (p = 0.110). However, procedural time was lengthier in CST than that in PDT (39.0 [30.0 – 60.0] min vs. 15.0 [11.0 – 23.0] min, p < 0.001). Procedure-induced complications were more common in patients who underwent CST compared to those in patients who underwent PDT (26.3% vs. 11.5%, p = 0.039). Although moderate or major bleeding occurred in five patients who underwent CST, only one patient had moderate bleeding in PDT. Especially, there were two respiratory arrests during procedure in CST. In addition, two VAPs and seven wound infections occurred in CST.
Conclusions
PDT performed by a neurointensivist may be safe and feasible compared to CST in neurosurgery patients and neurocritically ill patients.

Keyword

Percutaneous dilatational tracheostomy; Neurointensivist; Neurosurgery intensive care unit