Safety of percutaneous tracheostomy in trauma patients

Introduction

Percutaneous tracheostomy is a common procedure in many trauma ICUs. A concern about the safety of performing percutaneous tracheostomy in patients with no cervical spine clearance or cervical spine injury has limited its adoption for some surgeons. Most experts recommend the use of fiberoptic bronchoscopy during the insertion of percutaneous tracheostomy.

Methods

From January 2001 to December 2007 we retrospectively evaluated the medical records of all patients with blunt trauma who required tracheostomy in a level II trauma center. Data were gathered from a trauma registry database and medical records. Patients were divided in two groups, open tracheostomy (OT) and percutaneous tracheostomy (PT). Patient age, Injury Severity Score (ISS), type of tracheostomy insertion method, cervical spine clearance status prior to tracheostomy, presence of cervical spine injury, use of bronchoscopy assistance in percutaneous tracheostomy, and immediate complications post tracheostomy were recorded for each patient.

Results

The total number of tracheotomies during the study period was 220, of which 125 (56%) were PT and 95(44%) were OT. Both groups were similar in age, sex and ISS distribution. Of the OT group, 60 (63%) were done in patients with no cervical spine clearance or cervical spine injury. There were no immediate complications reported in the OT group. The PT group had 63 cases (50.4%) done with no preoperative cervical spine clearance or positive for cervical spine injury. The PT group underwent the procedure without bronchoscopy assistance in 95% of the cases. Two cases (1.5%) in the PT group were reported with postoperative bleeding from the tracheostomy site that did not required intervention. Both cases were PT done without bronchoscopy assistance and did not have preoperative cervical spine clearance. No other immediate complications were reported.

Conclusions

The results of this study suggest that PT is safe in trauma patients without preoperative cervical spine clearance or with cervical injuries as compared with the OT group. Most of the PT cases were done without bronchoscopy assistance (95%). This finding suggests the need for further study to clarify the role of bronchoscopy assistance in PT.