High‐Volume Tracheostomies in the Critically Ill Population: Analysis of Technique and Indications

Abstract

Objectives: Analyze the frequency of and techniques used in performing tracheostomies. Understand the prevailing contraindications used in the decision between open versus percutaneous method. Evaluate outcomes among the 2 modes of tracheostomy procedures. Methods: Case-series review of all patients who underwent a tracheostomy spanning 4 years within a tertiary metropolitan hospital. Clinical and demographic data were used to compare the 2 groups of patients with respect to average age, hospital stay, related emergency department (ED) visits, and other complications. Results: A total of 1333 tracheostomies were performed on 1302 patients. This included 452 (34%) open versus 881 (66%) via the percutaneous dilatational technique (PDT). There was no difference in short-term complications between the 2 groups. The primary long-term complication, tracheal stenosis, occurred most commonly in the PDT group. The contraindications practiced in decision for open versus PDT are not uniform among the various services performing tracheostomies. Approximately 26% of all discharged patients presented to the ED with respiratory or tracheostomy-related complaint within 90 days of discharge. Conclusions: We present the largest tracheostomy case-series containing a majority performed via the percutaneous technique. Tracheal stenosis is the most common long-term complication seen primarily among PDT group, indicating that factors such technique may lead to such outcomes. Institutional adoption of absolute contraindications may be necessary to avoid long-term complications. The development of an institutional common pathway for care and follow-up may help avoid related ED visits.