Bedside Conventional Tracheostomy in ICU: A Multicenter Experience from Bangladesh

Abstract

Tracheostomy is one of the most frequent procedures performed in intensive care unit (ICU) patients. It has many advantages like patient’s comfort, early movement from the ICU, and shorter ICU and hospital stay. Of the various techniques, we practice bedside open procedure tracheostomy for ICU patients considering the safety and cost effectiveness.Aim: To observe the common indications and timing of tracheostomy in our circumstances.Method: This cross-sectional study was carried out in 11 ICUs of Dhaka city from January 2008 to June 2015. All ICU patients, irrespective of age and sex , whose tracheostomy were done after admission in ICU at bedside by the principal author with associates were included in this study.Result: Bedside conventional tracheostomy was done in 345 ICU patients during the study period. Among them, 65% were male and 35% were female. Mean age of the patients was 44.30. Common indications for tracheostomy were cerebro-vascular disease (36%), laryngeal oedema (20%), advanced malignancy (16%), and trauma (12%). Only 54 patients had complications like hemorrhage (6%), surgical emphysema (3%), tube displacement (3%), wound infection (2%) and pneumothorax (1%).Conclusion: Bedside conventional tracheostomy is safe and efficient with low morbidity. Mortality is not worse and may be improved with earlier provision, especially in head-injured and critically ill medical patients. The timing of tracheostomy continues to be individualized, and should include daily weaning assessment, and can generally be made within 7 days of endotracheal intubation.Bangladesh Crit Care J September 2016; 4 (2): 65-68

Cricothyrotomy - In Unanticipated Difficult Intubation Cases with Respiratory Compromise

“…Moreover, these procedures require a lot of skill development. 29 Percutaneous tracheostomy and cricothyrotomy cases were low in number to assess its significance. This was due to patients suffering from cervical spine injuries being difficult to shift to the operation theatre; patients who underwent percutaneous tracheostomy were under high level of respiratory support.…”

“…11 The only obstacle is the lack of experience or timely recognition of the need to perform this procedure. 29 …”

“…11 The only obstacle is the lack of experience or timely recognition of the need to perform this procedure. 29 The advantages and features of cricothyrotomy over other procedures are that no major vessels intervene in the cricothyroid membrane area, the localization is easy in patients with thin necks, it can be performed in obese patients by sliding the finger from the thyroid angle and feeling the lower border of the cartilage in the midline, rapid entry, and placing the tracheostomy tube and inflating the cuff immediately will prevent both bleeding and subcutaneous emphysema.…”