Table 2 Procedural features of percutaneous dilatational tracheostomy performed in the intensive care unit
From: Tracheostomy procedures in the intensive care unit: an international survey
Response rate | Statistics | |||
|---|---|---|---|---|
Total | Europe | Outside Europe | ||
Who performed PDT in ICU | ||||
- One or more intensivists | 208/281 (74 %) | 166/208 (79.8 %) | 42/73 (57.5 %) | |
- Intensivist with ENT specialists | 16/281 (5.7 %) | 10/208 (4.8 %) | 6/73 (8.2 %) | |
- Intensivist with general surgeon | 6/281 (2.1 %) | 1/208 (0.5 %) | 5/73 (6.8 %) | X 2 = 51.732 |
- Intensivist with other surgeon | 8/281 (2.8 %) | 5/208 (2.4 %) | 3/73 (4.1 %) | P = 0.000 |
- Anesthesiologist | 18/281 (6.4 %) | 17/208 8.2 %) | 1/73 (1.4 %) | |
- ENT specialists | 15/281 (5.3 %) | 7/208 (3.4 %) | 8/73 (11 %) | |
- General surgeon | 7/281 (2.5 %) | 1/208 (0.5 %) | 6/73 (8.2 %) | |
- Another surgeon | 3/281 (1.1 %) | 1/208 (0.5 %) | 2/73 (2.7 %) | |
Most frequent indication | ||||
- Prolonged mechanical ventilation | 151/281 (53.7 %) | 107/208(51.4 %) | 44/73 (60.3 %) | |
- Difficult/prolonged weaning | 68/281 (24.2 %) | 55/208 (26.4 %) | 13/73 (17.8 %) | X 2 = 9.039 |
- Neurocritical disease (medical, disease, surgical or trauma involving the neurologic system) | 41/281 (14.6 %) | 32/208 (15.4 %) | 9/73 (12.3 %) | P = 0.171 |
- Inability to perform airway protection | 12/281 (4.3 %) | 8/208 (3.8 %) | 4/73 (5.5 %) | |
- Inability to cough and swallow | 5/281 (1.8 %) | 4/208 (1.9 %) | 1/73 (1.4 %) | |
- Improvement of patient respiratory mechanics | 3/281 (1.1 %) | 1/208 (0.5 %) | 2/73 (2.7 %) | |
- Copious secretions | 1/281 (0.4 %) | 1/208 (0.5 %) | 0 | |
Most frequent timing | ||||
- <7days | 55/281 (19.6 %) | 47/208 (22.1 %) | 9/73 (12.3 %) | |
- 7–15 days | 153/281 (54.4 %) | 108/208 (51.9 %) | 45/73 (61.6 %) | X 2 = 9.707 |
- 15–21 days | 58/281 (20.6 %) | 43/208 (20.7 %) | 15/73 (20.5 %) | P = 0.046 |
- 21–30 days | 11/281 (3.9 %) | 7/208 (3.4 %) | 4/73 (5.5 %) | |
- >30 days | 4/281 (1.4 %) | 4/208 (1.9 %) | 0 | |
Mechanical ventilation mostly used | ||||
- Volume control ventilation | 119/281 (42.3 %) | 84/208 (40.4 %) | 35/73 (47.9 %) | |
- Pressure control ventilation | 102/281 (36.3) | 75/208 (36.1 %) | 27/73 (37 %) | |
- Minute volume/adaptive support ventilation | 13/281 (4.6 %) | 12/208 (5.8 %) | 1/73 (1.4 %) | X 2 = 15.504 |
- Bi-level airway pressure | 34/281 (12.1 %) | 30/208 (14.4 %) | 4/73 (5.5 %) | P = 0.004 |
- Other | 13/281 (4.6 %) | 7/208 (3.4 %) | 6/73 (8.2 %) | |
Sedation-analgesia-neuromuscular blocking protocol provided | ||||
- Yes | 221/278 (79.5 %) | 163/207 (78.7 %) | 58/71 (81.7 %) | X 2 = 0.456 |
- No | 57/278 (20.5 %) | 44/207 (21.3 %) | 13/71 (18.3 %) | P = 0.500 |
Local anesthesia provided | ||||
- Yes | 179/276 (64.9 %) | 124/206 (60.2 %) | 55/70 (78.6 %) | X 2 = 12.859 |
- No | 97/276 (35.1 %) | 82/206 (39.8 %) | 15/70 (21.4 %) | P = 0.000 |
Bronchoscopy used during PDT | ||||
- Yes | 180/260 (69.2 %) | 153/194 (78.9 %) | 39/66 (59.1 %) | X 2 = 48.827 |
- No | 80/260 (30.8 %) | 41/194 (21.1 %) | 27/66 (40.9 %) | P = 0.000 |
Bronchoscopy during PDT performed | ||||
- Through ETT in place | 232/267 (86.9 %) | 176/201(87.6 %) | 56/66 (84.8 %) | |
- Replacement with larger ETT | 16/267 (6 %) | 12/201 (6 %) | 4/66 (6.1 %) | X 2 = 0.807 |
- Replacement with smaller ETT | 3/267 (1.1 %) | 2/201 (1 %) | 1/66 (1.5 %) | P = 0.848 |
- Through LMA | 16/267 (6 %) | 11/201 (5.5 %) | 5/66 (7.6 %) | |
- Diameter of bronchoscope used | ||||
- 3–4 mm | 40/220 (18.2 %) | 34/169 (20.2 %) | 6/52 (11.5 %) | |
- 5 mm | 86/220 (39.1 %) | 72/169 (42.9 %) | 14/52 (26.9 %) | X 2 = 17.268 |
- 6 mm | 65/220 (29.5 %) | 45/169 (26.8 %) | 20/52 (38.5 %) | P = 0.001 |
- 7 mm | 29/220 (13.2 %) | 17/169 (10.1 %) | 12/52 (23.1 %) | |
- ≥8 mm | 0 | 0 | 0 | |
Bronchoscope was chosen | ||||
- According to availability in ICU | 143/224 (63.8 %) | 110/171 (64.3 %) | 33/53 (62.3 %) | |
- According the size of ETT in place | 51/224 (22.8 %) | 37/171 (21.6 %) | 14/53 (26.4 %) | X 2 = 1.051 |
- Always with the smallest diameter | 30/224 (13.4 %) | 24/171 (14 %) | 6/53 (11.3 %) | P = 0.591 |
- Randomly without assessment | 0 | 0 | 0 | |
Neck ultrasound for PDT used | ||||
- To guide needle, dilator and cannula placement | 25/118 (21.2 %) | 18/95 (18.9 %) | 7/23 (30.4 %) | X 2 = 5.966 |
- In suspected at-risk structure | 81/118 (68.6 %) | 69/95 (72.6 %) | 12/23 (52.2 %) | P = 0.051 |
- Both together | 127118 (10.2 %) | 8/95 (8.4 %) | 4/23 (17.4 %) | |
Tracheostomy tube used | ||||
- Cuffed | 118/257 (45.9 %) | 89/194 (45.9 %) | 29/63 (46 %) | |
- Cuffed with inner cannula | 94/257 (36.6 %) | 75/194 (38.7 %) | 19/63 (30.2 %) | X 2 = 6.568 |
- Both | 43/257 (16.7 %) | 28/194 (14.4 %) | 15/63 (23.8 %) | P = 0.087 |
- Other | 2/257 (0.8 %) | 2/194 (1 %) | 0 | |