P-210PROSPECTIVE OBSERVATIONAL STUDY OF PERCUTANEOUS TRACHEOSTOMY WITH SPECIAL ATTENTION TO THE ROLE OF BRONCHOSCOPY AND SURGICAL TECHNIQUE

• Published in: Interactive cardiovascular and thoracic surgery 2013-07, Vol.17 (suppl_1), p.S55-S55
• Main Authors: Jakobson, E., Sarana, B., Sarapuu, S., Elmet, K., Reinhardt, V., Vahtramäe, J., Laisaar, Tanel
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt288.210

Objectives Percutaneous tracheostomy has become a routine procedure in intensive care. However, considerable variation exists in the procedure. The aim of the current study was to evaluate the role of intraoperative bronchoscopy and to compare various surgical techniques of tracheostomy. Methods During a one-year period all percutaneous tracheostomy cases in three intensive care units of one hospital were prospectively documented according to a unified protocol. In one unit bronchoscopy was used during the whole procedure and in two units only to determine the position of the guiding needle. Results A total of 111 patients (34 females, 77 males) with a median age of 64 (range 18-86) years and body mass index (BMI) of 25.4 (range 15.9-50.7) were included. In unit “A” anterior tracheal wall was directly exposed; in unit “B” limited dissection to enable immediate tracheal wall palpation was made. Bronchoscopy was used to check the location of an already inserted guiding needle. In these units needle position required correction in 8 and 12% of cases, respectively. In unit “C” bronchoscopy was used to guide needle insertion without dissection of pretracheal tissue; the position of the needle required correction in 66% of cases. Median duration of operations performed by a thoracic surgeon or a surgical resident (unit “B”) was 10 min (range 3-37); operations performed by an ICU doctor or a resident 16.5 min (range 3-63) (P < 0.001). Time since beginning of preparations until the end of the whole procedure was median 32 minutes when tracheostomy was performed in an ICU bed and 64 minutes when in an ICU theatre (P < 0.001). Conclusions Surgical dissection of pretracheal tissue to expose the anterior wall of trachea allows proper guiding needle insertion and bronchoscopic support is rarely needed. Procedures performed by a thoracic surgeon are faster and performing tracheostomy in an ICU bed saves considerable time. Disclosure All authors have declared no conflicts of interest.