[Bronchoscopy-guided percutaneous tracheostomy. A safe technique in intensive care]

Abstract

Introduction: When compared with conventional surgery, bronchoscopy-guided percutaneous tracheostomy has demonstrated some advantages. We compare the results obtained with bronchoscopy-guided percutaneous tracheostomy performed by Intensive Care Unit personnel with those of conventional surgery.

Methods: Prospective and descriptive cohort of patients admitted to a respiratory intensive care unit from March 2010 to March 2012.

Results: A total of 510 patients were admitted to the respiratory Intensive Care Unit. Tracheostomy was performed in 51 (10%); of which, 27 (53%) underwent bronchoscopy-guided percutaneous tracheostomy, and 24(47%) underwent tracheostomy by conventional surgery. There were no differences between bronchoscopy-guided percutaneous tracheostomy and conventional surgery groups in age (52 ± 16 vs 53 ± 18 years, p = 0.83). Simplified Acute Physiology Score-3 differed among groups (59.4 ± 11.2 vs 51.5 ± 14.3, p = 0.03). Indications for performing tracheostomy were prolonged intubation (74.1% vs 62.5%, p = 0.55), neurologic impairment (22.2% vs 16.6%, p = 0.88), and laryngeal disease (3.7% vs 20.8%, p 0.14). Mean time between intubation and tracheostomy was 13.3 days (range 4-45) vs 13.4 days (range 2-40). There were three minor complications in bronchoscopy-guided percutaneous tracheostomy patients, transient bigeminism in one, and moderate bleeding in two, and one minor complication of moderate bleeding in one patient in the conventional surgery group, p = 0.68.

Conclusion: Bronchoscopy-guided percutaneous tracheostomy is a versatile and safe alternative for conventional tracheostomy when performed in Intensive Care Unit by personnel with expertise and appropriate training.

Keywords: Intensive Care Units; bronchoscopy; percutaneous tracheostomy.