Complications during tracheal intubation and percutaneus dilatational tracheostomy in the ICU

Objective

This study investigates the immediate complications and adverse consequences of endotracheal intubation (ETI) and bedside percutaneus dilatational tracheostomy (PDT) performed in ICU patients.

Design

Prospective observational study.

Setting

Two 15-bed general ICU units in a 600-bed general hospital.

Subjects

All ETI and PDT that were carried out in our ICUs, over a period of 6 months, were studied prospectively. The procedures were performed by skilled ICU attending physicians or by supervised residents. Complications and adverse consequences, which occurred during the procedures, were recorded, as well as sedatives, muscle relaxants and any other drug used, according to a previously approved protocol.

Results

One hundred and forty-two ETI and 54 PDT were carried out successfully. Complications occurred in 41% of ETI and 33% of PDT cases. Major ETI complications including difficult or esophageal intubation, aspiration, desaturation of hemoglobin and severe hypotention, were recorded in 34.5% of cases. Local injury and transient hypotention occurred in 9% of cases. Severe complications (bleeding, false passage of tracheostomy tube, desatura-tion of hemoglobin, severe hypotention) occurred in 15% of PDT cases. Minor complications that are false or difficult passage of the guide wire and puncture of the ET tube were noted in 19% of cases. No difference was recorded in the incidence of complications regardless of whether the procedure was performed by the attending physicians or the supervised residents. The only incidence that was statistically higher in the ETI group (P < 0.01329, χ² test) was desaturation. Also no significant differences were recorded between the groups treated with different sedatives and analgesics.

Conclusions

1) Adverse consequences and complications commonly happen in the ICU during ETI and PDT. 2) ETI and PDT can be safely performed by supervised residents.