Bedside percutaneous tracheostomy: experience with 40 critically ill patients

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In intensive care unit patients requiring prolonged mechanical ventilation, tracheostomy is necessary. As an alternative to the standard surgical method, percutaneous techniques are available.

Since November 1996, 40 patients (34M, 6F) have been electively selected for percutaneous tracheostomy (PCT) at a University Hospital with a 9-bed combined medical-surgical ICU. PCT was performed at bedside with the Portex Percutaneous Tracheostomy Kit (Portex Ltd, Kent, England). The procedure time and early complications were recorded.

Patients were between 18 and 86 years (46.4 ± 3.1). The procedure was successful in all patients and the average duration of placement was 9.05 ± 0.7 min (3–20 min). An 8 or 8.5 mm cannula was inserted in each case, introduced between the 1st and 2nd or 2nd and 3rd tracheal cartilages.

The average duration of artificial ventilation before PCT was 9.8 ± 0.8 days (2-28 days), after PCT was 12.1 ± 1.2 days (1–32 days). Mean duration of PCT was 20.9 ± 3.6 days (1–140 days). There were no PCT-related deaths. The only procedure related complication was bleeding at the stoma site which resolved within applied pressure. 20 patients were decannulated. Early clinical examination revealed hoarseness in one patient. Stomas were closed within a few days, leaving an approximately 1 cm length scar.

Our study suggests that PCT is a simple and safe method and can be performed rapidly at the bedside in the ICU.