Fiber optic bronchoscopy-assisted percutaneous tracheostomy: a decade of experience at a university hospital

Romero, Carlos; Cornejo, Rodrigo; Tobar, Eduardo; Gálvez, Ricardo; Luengo, Cecilia; Estuardo, Nivia; Neira, Rodolfo; Navarro, José Luis Alfaro; Abarca, Osvaldo; Ruiz, Mauricio; Berasaín, María Angélica; Neira, Wilson R.; Arellano, D.; Llanos, Osvaldo

doi:10.5935/0103-507x.20150022

Cited by 6 publications

(6 citation statements)

References 37 publications

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“…Percutaneous tracheostomy using the dilation technique under FBS assistance would be effective and safe in preventing serious complications or deaths in critical care patients under mechanical ventilation [6]. In our study, three percutaneous tracheostomies were performed.…”

Section: Discussionmentioning

confidence: 93%

Indications and findings of flexible bronchoscopy in trauma field in Korea: a case series

Noh

2023

J Trauma Inj

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Purpose: Since its implementation, flexible fiberoptic bronchoscopy (FBS) has played an important role in the diagnosis and treatment of tracheobronchial tree and pulmonary disease. Although FBS is often performed by endoscopists, it has also been performed by surgeons, albeit rarely. This study investigated FBS from the surgeon’s perspective.Methods: This retrospective study included patients who underwent FBS performed by a single thoracic surgeon between March 2017 and December 2021. Accordingly, the epidemiology, purpose, results, and complications of FBS were analyzed.Results: A total of 47 patients received FBS, whereas 13 patients underwent repeat FBS. Their mean age was 60.7 years. The main organs injured involved the chest (n=22), brain (n=9), abdominal organ (n=7), cervical spine (n=4), extremities (n=4), and face (n=1). The average Injury Severity Score was 22.5. Indications for FBS included atelectasis or haziness on chest x-ray (n=34), pneumonia (n=17), difficult ventilator management (n=7), percutaneous dilatory tracheostomy (n=3), blood aspiration (n=2), foreign body removal (n=2), and intubation due to a difficult airway (n=1). The findings of FBS were mucous plugs (n=36), blood and blood clots (n=16), percutaneous dilatory tracheostomy (n=2), foreign bodies (n=2), granulation tissue at the tracheostomy site (n=2), tracheostomy tube malposition (n=1), bronchus spasm (n=1), difficult airway intubation (n=1), and negative findings (n=5). None of the patients developed complications. Conclusions: FBS is an important modality in the trauma field that allows for the possibility of diagnosis and therapy. With sufficient practice, surgeons may safely perform FBS at the bedside with relative ease.

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Section: Discussionmentioning

confidence: 93%

Indications and findings of flexible bronchoscopy in trauma field in Korea: a case series

Noh

2023

J Trauma Inj

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“…In contrast, Romero et al, in their description of bronchoscopy-guided procedures, reported fewer minor complications and no major complications in their cohort. ( 21 )…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of tracheoesophageal fistula was low (0.9%) and comparable to the literature, ( 13 ) although there are reports from the literature of such fistulas not occurring with the use of bronchoscopic guidance. ( 21 )…”

Section: Discussionmentioning

confidence: 99%

Intensivist-led ultrasound-guided percutaneous tracheostomy: a phase IV cohort study

Bustamante,

Besen,

Botêga

et al. 2023

Crit Care Sci

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Objective To describe, with a larger number of patients in a real-world scenario following routine implementation, intensivist-led ultrasound-guided percutaneous dilational tracheostomy and the possible risks and complications of the procedure not identified in clinical trials. Methods This was a phase IV cohort study of patients admitted to three intensive care units of a quaternary academic hospital who underwent intensivist-led ultrasound-guided percutaneous tracheostomy in Brazil from September 2017 to December 2021. Results There were 4,810 intensive care unit admissions during the study period; 2,084 patients received mechanical ventilation, and 287 underwent tracheostomy, 227 of which were performed at bedside by the intensive care team. The main reason for intensive care unit admission was trauma, and for perform a tracheostomy it was a neurological impairment or an inability to protect the airways. The median time from intubation to tracheostomy was 14 days. Intensive care residents performed 76% of the procedures. At least one complication occurred in 29.5% of the procedures, the most common being hemodynamic instability and extubation during the procedure, with only 3 serious complications. The intensive care unit mortality was 29.1%, and the hospital mortality was 43.6%. Conclusion Intensivist-led ultrasound-guided percutaneous tracheostomy is feasible out of a clinical trial context with outcomes and complications comparable to those in the literature. Intensivists can acquire this competence during their training but should be aware of potential complications to enhance procedural safety.

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“…[9][10][11][12][13][14][15][16] Studies have also identified intraoperative complications associated with PT such as death, hemorrhage, pneumothorax, and postoperative complications including bleeding, infection, and tracheostomy tube obstruction. [17][18][19][20][21][22] However, surgical OT runs similar risks as well.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Review of 589 Percutaneous Tracheostomies in a Canadian Community Teaching Hospital

Shin

Chan

2021

Ear Nose Throat J

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Objective: The primary objective of this study was to review the complication rate of percutaneous tracheostomies performed by a single surgeon in a community teaching hospital. Methods: This retrospective study reviewed the patients who underwent percutaneous tracheostomy with bronchoscopic guidance in a community hospital setting between 2009 and 2017. Patients older than the age of 18 requiring percutaneous tracheostomy were chosen for this retrospective study. Patients who were medically unstable, had no palpable neck landmarks, and inadequate neck extension were excluded. Indications for percutaneous tracheostomy included patients who had failed to wean from mechanical ventilation, required pulmonary toileting, or in whom airway protection was required. Results: Of the 600 patients who received percutaneous tracheostomy, 589 patients were included in the study. Intraoperative complication (2.6%) and postoperative complication rates (11.4%) compared similarly to literature reported rates. The most common intraoperative complications were bleeding, technical difficulties, and accidental extubation. Bleeding, tube obstruction, and infection were the most common postoperative complications. Overall burden of comorbidity, defined by Charlson Comorbidity Index, and coagulopathy were also found to be associated with higher complication rates. The decannulation rate at discharge was 46.3%. Conclusion: Percutaneous tracheostomy is a safe alternative to open tracheostomies in the community setting for appropriately selected patients.

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Fiber optic bronchoscopy-assisted percutaneous tracheostomy: a decade of experience at a university hospital

Cited by 6 publications

References 37 publications

Indications and findings of flexible bronchoscopy in trauma field in Korea: a case series

Indications and findings of flexible bronchoscopy in trauma field in Korea: a case series

Intensivist-led ultrasound-guided percutaneous tracheostomy: a phase IV cohort study

A Retrospective Review of 589 Percutaneous Tracheostomies in a Canadian Community Teaching Hospital

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