An audit of perioperative staffing and complications during percutaneous and surgical tracheostomy insertion
© BioMed Central Ltd 2008
Published: 13 March 2008
Percutaneous tracheostomy (PDT) has been established as a safe technique in the critically ill, with an equivalent complication rate to surgical tracheostomy (ST). However, PDT insertion may result in unrecognised hypercarbia, and has been associated with an increased perioperative complication rate. We therefore decided to audit current practice within our ICU.
Over a 3-month period, prospective data were collected on 25 patients within a 14-bed regional ICU. A single observer collected data on staff present, cardiovascular recordings and end-tidal carbon dioxide.
Staff involved in PDT and ST
Assistants ≥ 2
This audit has shown that assistance for PDT is inferior to that provided in the operating theatre, and this has potential safety implications particularly when junior staff are anaesthetising. Perioperative complication rates were similar overall, confirming the safety of PDT as a technique. Hypercarbia occurred relatively frequently during PDT, however, which may have deleterious effects in the brain-injured patient. From this audit, we would recommend that within our ICU more attention be focused on adequate staffing during the performance of this operative procedure on critically ill patients. Also, end-tidal carbon dioxide should be monitored carefully and treated if elevated.