PERCUTANEOUS DILATATIONAL TRACHEOSTOMY: A PROSPECTIVE ANALYSIS ABOUT THE SAFETY OF PROCEDURE AMONG ICU PATIENTS

Abstract

Objective: To evaluate the percutaneous dilatational tracheostomy procedure
safety among the critically ill Medical ICU patients.
Methodology: The study was descriptive and conducted in Medical ICU, Department
of Pulmonary and Critical Care Medicine, Services Institute of Medical
Sciences, Lahore, from February 2015 to May 2016. Fifty three Medical
ICU patients underwent tracheostomy procedure through percutaneous dilatational
technique using both Grigg's and Ciaglia's methods. Procedure was
performed at bed side using local anesthesia, sedation and systemic analgesia,
under bronchoscopic guidance. Patients were monitored for intraprocedural
and postprocedural complications like: hemorrhage, stomal infection, injury to
adjacent structures, arrhythmias, transient hypoxemia, transient hypotension,
paratracheal insertion, pneumothorax, sub-cutaneous emphysema, loss of airway,
accidental decannulation, tracheal ring fracture and new lung infiltrate or
atelectasis.
Results: A total of 53 procedures were performed. Intraprocedural complications
included: Transient hypoxemia 4/53 (7.5%) & hypotension 3/53 (5.6%),
hemorrhage 3/53 (5.6%) & one case of paratracheal placement. No procedure
related mortality was noted. 10 patients died during the ICU stay due to the primary
underlying disease and one patient died after a successful decannulation.
36 patients had uneventful decannulation. Six patients were directly discharged
from ICU.
Conclusion: Percutaneous dilatational tracheostomy is a safe procedure with
low complications rate and suitable for critically ill ICU patients.