Bedside Tracheostomy in the Intensive Care Unit

Abstract

Bedside tracheostomy in the intensive care unit can be performed with morbidity and mortality rates comparable to operative tracheostomy. In addition, it provides a significant cost savings for the patient.

Complications of midline‐open tracheotomy in adults

“…With the exception of Wease, OT has been the subject of studies comparing OT and PT. [9][10][11][12][13][14][15][16][17][18] Complication rates of OT were predominantly evaluated in small patient populations including 50, 26, and 29 patients, respectively. 11,13,14 In contrast to studies evaluating PT, high-risk patients were included in studies evaluating OT.…”

“…Of all tracheotomies, 72.9% were performed in the first 3 weeks after endotracheal intubation (Table II). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] The period of cannulation varied strongly (range, 1-730 days) (n ¼ 291). In 146 patients (49.5%), the cannula remained in situ for a time period between 1 week and 1 month (20.3% 1-7 days and 25.3% 30-90 days).…”

Open Bedside Tracheostomy: Routine Procedure for Patients Under Prolonged Mechanical Ventilation

“…So it has been thought that the procedure should be performed in the OR because of the need for adequate lighting, instruments, and support facilities. 16 However, some problems must be handled under this circumstance, including the hazard of moving critically ill patients to OR, 18 the associated cost, and the inconvenience of OR schedules. The PDT procedure popularized by Ciaglia et al 8 helped to resolve some of these issues.…”

“…Unfortunately, exclusion criteria such as anatomic features (obesity and cervical features such as distance between cricoid and supraesternal notch), 16,19 physicians preference, 16 and/or higher FiO 2 requirements, 18 limit a more widespread use of bedside procedures (both PDT and OBT). In a bedside tracheostomy trial, 164 patients were eligible, but only 100 received the bedside procedure.…”

“…This approach has proved to be safe in selected patients. [15][16][17][18][19] In a prospective randomized study, Massick et al 19 found excellent results and stated that OBT represents the standard of care in bedside tracheostomy, since it provides a more secure airway at markedly reduced patient charge. However, the use of very rigid selection criteria excluded many patients who might have benefited from this approach.…”