[Role of percutaneous tracheostomy in intensive care: a review]

Abstract

Introduction: Performing early tracheostomy is a possible solution during prolonged ventilation in order to decrease late complications. Considering the duration of procedure and the hazards concerning the patient transport the risk of operation is high in the critically ill patients. Therefore bedside percutaneous tracheostomy (PCT) plays an increasing role in intensive therapy.

Aims: For emphasizing the widening role of PCT in intensive care the procedures were analysed in the mirror of international experiences. After introducing short history of the procedure the improvement of techniques is presented.

Methods: A description of the experiences with the three main techniques is presented based on early original publications. Analyzing the results of comparative studies the risks and benefits of different methods were investigated in focus of the early and late complications.

Results: Comparing the percutaneous and surgical techniques significantly lower number of late complications were observed in PCT groups by several studies but there is a debate concerning the early hemorrhagic complications. Among the percutaneous techniques there was no significant difference between the occurrence of complications. The greatest experience has been gathered with the sequential dilatation technique. The duration of procedure was the only significant difference between the sequential and forceps dilatational technique.

Conclusions: According to the international literature the percutaneous tracheostomy is the procedure of choice for prolonged airway management for high-risk intensive care patients. Concerning the elevated risk of operation the percutaneous techniques have significantly shorter duration and lower rate of late complications. Among the different percutaneous techniques the only significant difference was the duration of the procedure. The shortest procedure was the forceps dilatational technique.