Early experience of intensive postoperative unit (IPU): percutaneous tracheotomy as the first option after long-term oro-tracheal intubation

Background

Surgical tracheotomy has been used as the first choice procedure in most intensive care units after long-term artificial ventilation. Percutaneous access is an option in such patients, and the clinical staff can perform it.

Objective

To evaluate the early experience in performing the procedure, including the timing of its indication, its complications, its safety in thoracotomized patients and followup.

Patients and method

Fifteen adult patients who underwent percutaneous tracheotomy in the IPU were retrospectively studied. Between December 1999 and January 2001, the following were evaluated: admission diagnosis, length of mechanical ventilation before and after the procedure, complications and patient follow-up. The only patient whose procedure was previously not indicated for technical consideration was excluded from this analysis. Eight patients were admitted after open-heart surgery. Three patients were admitted after neuro-surgery and another one after a correction of ruptured abdominal aortic aneurysm. Three patients were admitted for clinical reasons.

Results

In one patient intense local bleeding complicated the percutaneous procedure and a surgical tracheotomy was needed. All other procedures were successfully performed. Two open-heart surgery patients, one neurosurgical and one clinical, died in follow-up analysis. The mean time for procedure indication was 9.3 days (4-18 days). Local infection or mediastinytis were not reported. The mean mechanical ventilation time after procedure was 12.4 days. Two patients were transferred to another institution, and therefore the follow up was lost. The deaths were not related to the percutaneous tracheotomy intervention.

Conclusion

Percutaneous tracheotomy was considered to be a safe procedure for obtaining an artificial air pathway in long-term artificially ventilated patients in this series, including those who underwent open-heart surgery. Since only a small number of patients were included in this study, further evaluation is mandatory for supporting this conclusion.