Open Access

Percutaneous tracheostomy: it’s time for a shared approach!

Critical Care201418:448

https://doi.org/10.1186/cc13974

Published: 7 July 2014

In a previous issue of Critical Care, Simon and colleagues [1] reported the incidence of death related to percutaneous tracheostomy (PT). Fatal complications occurred in 31% of cases during the procedure and in 49% of cases within the first week of the tracheostomy [1]. In a later issue of Critical Care, Rajendran and Hutchinson [2] suggested the use of a checklist, adapted from the World Health Organization (WHO) surgical safety checklist, to improve safety and reduce errors and harm related to the PT procedure in critical care. However, a recent observational study performed in 101 hospitals in Ontario, Canada, did not find any reduction in mortality or complications after the implementation of the WHO checklist in more than 100,000 surgical procedures [3].

PT is widely used in critical care, although no clinical guidelines have been developed to suggest the best practice for this invasive and risky procedure. Surveys on PT, performed in different European countries, have shown the presence of a shared clinical practice [4]. We think that, lacking clinical guidelines to provide the best available scientific evidence and to reduce inappropriate variation in PT practice, a careful analysis of different surveys may suggest to physicians the most common practice associated with PT. Table 1 shows shared clinical practice for PT from an analysis of seven national surveys performed in France (where 152 intensive care units participated in the survey), Germany (505), Italy (130), The Netherlands (63), Spain (100), Switzerland (48), and the UK (197).
Table 1

Shared clinical practice for percutaneous tracheostomy from an analysis of seven national surveys in Europe

Findings

Most common practice

Indications

Long-term mechanical ventilation, weaning failure, and upper airway obstruction

Techniques

Ciaglia single dilator and guide-wire dilating forceps

Timing

7 to 15 days after intensive care unit admission

Involved physicians in percutaneous tracheostomy

Intensivists; ear, nose, throat specialist; and general surgeon

Neck ultrasound evaluation

Screening before the procedure to assess at-risk structure

Ventilation protocol

Largely used with volume-controlled ventilation

Sedation protocol

Largely used in association with local anesthesia, analgesia, and neuromuscular blocking

Airway management

Endotracheal tube in place

Fiberoptic bronchoscopy

Largely used

Diameter of fiberoptic bronchoscope

3 to 5 mm

Intraprocedural complications

Minor bleeding

The analysis was of seven national surveys performed in France (where 152 intensive care units participated in the survey), Germany (505), Italy (130), The Netherlands (63), Spain (100), Switzerland (48), and the UK (197).

Abbreviations

PT: 

percutaneous tracheostomy

WHO: 

World Health Organization.

Declarations

Authors’ Affiliations

(1)
Department of Neurosciences, Reproductive and Odontosthomatological Sciences, University of Naples “Federico II”
(2)
Department of Surgical Sciences and Integrated Diagnostics-IRCCS San Martino IST, University of Genoa

References

  1. Simon M, Metschke M, Braune SA, Puschel K, Kluge S: Death after percutaneous tracheostomy: a systematic review and analysis of risk factors. Crit Care. 2013, 17: R258-10.1186/cc13085.PubMed CentralView ArticlePubMedGoogle Scholar
  2. Rajendran G, Hutchinson S: Checklist for percutaneous tracheostomy in critical care. Crit Care. 2014, 18: 425-10.1186/cc13833.PubMed CentralView ArticlePubMedGoogle Scholar
  3. Urbach DR, Govindarajan A, Saskin R, Wilton AS, Baxter NN: Introduction of surgical checklist in Ontario, Canada. N Engl J Med. 2014, 370: 1029-1038. 10.1056/NEJMsa1308261.View ArticlePubMedGoogle Scholar
  4. Vargas M, Servillo G, Arditi E, Brunetti I, Pecunia L, Salami D, Putensen C, Antonelli M, Pelosi P: Tracheostomy in intensive care unit: a national survey in Italy. Minerva Anestesiol. 2013, 79: 156-164.PubMedGoogle Scholar

Copyright

© Vargas et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Advertisement