Percutaneous dilatational tracheostomy in a medical ICU.

OBJECTIVE

To evaluate the safety of percutaneous dilatational tracheostomy.

DESIGN

A prospective clinical study.

SETTING

The intensive care unit of a university medical clinic.

PATIENTS

137 critically ill patients admitted between May 1993 and September 1996.

INTERVENTION

Percutaneous dilatational tracheostomy at the bedside.

RESULTS

The median duration of translaryngeal intubation prior to tracheostomy was 8 days. Tracheostomy was carried out within 12.8 min (range 7-30 min). Acute complications were documented in 11.0% of the patients. There was one case of severe bleeding with transient asphyxia. Four patients had tracheal mucosal laceration treated conservatively. The postoperative in-hospital complication rate was 5.1%, the sole problem being stomal bleeding. Only two cases of stomal infection were documented. There was no procedure-related mortality.

CONCLUSION

In the hands of the experienced, percutaneous dilatational tracheostomy is a safe and quick bedside procedure. It is also less expensive and incurs minimal stress for the patient compared with the surgical method. The technique can be easily mastered by non-surgical physicians and we feel that it is the method of choice for elective tracheostomy in the majority of intensive care patients.