EmÃdio Jorge Santos Lima
General Hospital Roberto Santos, Brazil
Title: Percutaneous tracheostomy without bronchoscopy: A safe procedure
Biography
Biography: EmÃdio Jorge Santos Lima
Abstract
Background: Tracheostomy is a common procedure in ICU, particularly as an approach for weaning from mechanical ventilation. In mid-1980s percutaneous tracheostomy (PCT) was introduced as a less invasive alternative for the standard surgical tracheostomy. A tracheostomy facilitates weaning from mechanical ventilation, in long-term ventilated patients, by improving airway cleaning, better patient comfort, and decreasing airway resistance. Prolonged mechanical ventilation has a main complication i.e., ventilator-associated pneumonia. In such cases early tracheostomy may reduce that complication. Methods: We analyzed prospectively 104 adult patients mean age of 53 years who underwent PCT at our ICU between 2012 and 2014. Inclusion criteria were: age >18 years and indication for tracheostomy. Exclusion criterion was technical contraindication for PCT. All the PCT were performed at bedside using Ciaglia technique. Results: Among 104 patients, reasons for PCT were: Weaning failures in 82 (78.85%) and airway protection in 22 (21.15%). The most frequent reasons for admission to the ICU were: Sepsis in 18 (17.31%), pneumonia in 17 (16.35%) and stroke in 7 (6.73%). The mean duration of preceding translaryngeal intubation was 9 days. The mean length of ICU stay was 14 days. We observed one complication in one patient; it was a tracheal stenosis. 66 patients (63%) died during their stay in the ICU. These deaths were unrelated to the PCT, but related to severe organ dysfunction. 38 patients (36.54%) survived and was discharged from the hospital, 37 was decannulated. Conclusion: PCT, in our series, was a safe and practical procedure for bedside management of critical patients.