Bedside Tracheotomy Results in few Complications

The chart information was reviewed by researchers who had no role in the procedures, and no patients were excluded from the analysis for any of the cases reviewed. The average age of the patients was 75.5 years, and 25 were men. The patients were intubated for an average of 11.6 days before the PDT procedure was performed.

The PDT was performed under general sedation, using a Ciaglia Blue Rhino Kit, a product of Cook Medical (Bloomington, In, USA), which is outfitted with an enhanced grip and a grooved distal surface to provide a simple, effective solution for PDT. The results showed that there was only one complication (excessive bleeding that resolved without formal exploration), and there were no procedure-related deaths. The study was presented as a poster session at the annual meeting of the Society of Critical Care Medicine (SCCM), held during January 2014 in San Francisco (CA, USA).

“PDT has become one of the most widely used procedures in ICUs worldwide offering the benefit of both being cost-effective and an overall safer technique for critically ill patients,” said lead author and study presenter Peter Abdelmessieh, DO. “Although PDT has been the preferred technique in our ICU, as well as at many other institutions, it has yet to be accepted by the surgical community.”

“There really is no difference in doing this at bedside or in the operating room. It is really based upon the experience of the practitioner, and it is based upon being able to fix your complications if you have them,” added Steven Blau, MD, a critical care surgeon at Good Samaritan Hospital Medical Center (West Islip, NY, USA), who moderated the SCCM poster session. “I have no problem doing [bedside PDT] at a community hospital. It works. The difficulty in getting people up three flights of stairs, or on an elevator to do a tracheotomy in the operating room, is a trip I have no enthusiasm for.”

To perform PDT, the endotracheal tube is withdrawn to the level of the cricothyroid membrane under bronchoscopic visualization, and a small incision is made in the midline between the first and second (or second and third) tracheal rings. A tracheotomy tube is then inserted in the trachea over a guidewire, using a series of dilators in the modified Seldinger technique, and is sutured in place. The endotracheal tube is then removed, and the ventilator is reconnected to the tracheotomy tube. Subsequent bronchoscopy through the endotracheal tube confirms placement.

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