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May 1996

Bedside Tracheostomy in the Intensive Care Unit

Author Affiliations

From the Department of Surgery, William Beaumont Hospital, Royal Oak, Mich.

Arch Surg. 1996;131(5):552-555. doi:10.1001/archsurg.1996.01430170098018

Objective:  To prove that tracheostomy performed at the bedside in the intensive care unit is a safe, cost-effective procedure.

Design:  Retrospective chart review of all adult patients undergoing elective bedside tracheostomy in the intensive care unit between January 1983 and December 1988. Two hundred four patients were identified.

Setting:  A private 1200-bed tertiary care center with a 120-bed critical care facility.

Main Outcome Measures:  Major and minor perioperative complications, cost savings, and comparison of risk between bedside tracheostomy and that performed in the operating room.

Results:  There were six major complications (2.9%): one death due to tube obstruction, two bleeding episodes requiring reoperation, one tube entrapment requiring operative removal, one nonfatal respiratory arrest, and one bilateral pneumothorax; and seven minor complications (3.4%): five episodes of minor bleeding, one tube dislodgement in a tracheostomy with a well-developed tract, and one episode of mucus plugging. One late complication (tracheal stenosis) was identified.

Conclusions:  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.(Arch Surg. 1996;131:552-555)