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Article
March 1996

Percutaneous Dilatational TracheostomyA Safe, Cost-effective Bedside Procedure

Author Affiliations

From the Department of Surgery, Maine Medical Center, Portland.

Arch Surg. 1996;131(3):265-271. doi:10.1001/archsurg.1996.01430150043008
Abstract

Objective:  To evaluate the safety and cost-effectiveness of percutaneous dilatational tracheostomy performed in the intensive care unit.

Design:  Retrospective review of 65 patients with cost-effectiveness analysis.

Setting:  University-affiliated tertiary care teaching hospital with a 34-bed combined medical-surgical intensive care unit.

Patients:  All patients who underwent percutaneous dilatational tracheostomy under the supervision of a single general surgeon during a 19-month period. Cost analysis was based on comparison with standard operative tracheostomies performed during the same period.

Results:  Percutaneous dilatational tracheostomy was completed in all patients in whom it was attempted, regardless of airway anatomy, body habitus, and ventilator settings. The mean duration of the procedure performed in the intensive care unit was 13.6 minutes (95% confidence interval, 11.7 to 15.5 minutes). Intraoperative complications occurred in 14 patients (22%), most of which were minor technical difficulties, and none resulted in serious morbidity. Postoperative complications occurred in six patients (9%), including one death secondary to premature decannulation, three bleeding complications, one episode of subcutaneous emphysema, and one air leak. Two long-term airway complications after percutaneous dilatational tracheostomy were documented during a mean 7.5-month follow-up of 28 patients. Mean patient charges for the procedure performed in the intensive care unit by a surgeon, nurse, and respiratory therapist were $997 (95% confidence interval, $975 to $1018) compared with $2642 (95% confidence interval, $2513 to $2772) for standard tracheostomy (P<.001). This represented a savings of$1645 (95% confidence interval, $1492 to $1798) per tracheostomy.

Conclusions:  Percutaneous dilatational tracheostomy is a safe, rapid, cost-effective alternative to standard open tracheostomy. It can be performed at the bedside, obviating the need to transport critically ill patients from their optimal intensive care unit environment.(Arch Surg. 1996;131:265-271)

References
1.
Roe BB.  Bedside tracheostomy . Surg Gynecol Obstet . 1962;115:239-241.
2.
Stock MC, Woodward CG. Shapiro BA, Cane RD, Lewis V, Pecaro B.  Perioperative complications of elective tracheostomy in critically ill patients . Crit Care Med . 1986;14:861-863.Article
3.
Indeck M, Peterson S, Smith J, Brotman S.  Risk, cost, and benefit of transporting ICU patients for special studies . J Trauma . 1988;28:1020-1025.Article
4.
Smith I, Fleming S, Cernaianu A.  Mishaps during transport from the intensive care unit . Crit Care Med . 1990;18:278-281.Article
5.
Ciaglia P, Firsching R, Syniec C.  Elective percutaneous dilatational tracheostomy—a new simple bedside procedure: preliminary report . Chest . 1985:87: 715-719.Article
6.
Ciaglia P, Graniero KD.  Percutaneous dilatational tracheostomy: results and long-term follow-up . Chest . 1992;101:464-467.Article
7.
Hazard PB, Garrett HE, Adams JW, Robbins ET, Aquillard RN.  Bedside percutaneous tracheostomy: experience with 55 elective procedures . Ann Thorac Surg . 1988;46:63-67.Article
8.
Cook PD, Callanan VI.  Percutaneous dilatational tracheostomy: technique and experience . Anaesth Intens Care . 1989;17:456-457.
9.
Marelli D, Paul A, Manolidis S, et al.  Endoscopic guided percutaneous tracheostomy: early results of a consecutive trial . J Trauma . 1990;30:433-435.Article
10.
Hazard P, Jones C, Benitone J.  Comparative clinical trial of standard operative tracheostomy with percutaneous tracheostomy . Crit Care Med . 1991;19:1018-1024.Article
11.
Bodenham A, Diament R, Cohen A, Webster N.  Percutaneous dilatational tracheostomy: a bedside procedure on the intensive care unit . Anaesthesia . 1991; 46:570-572.Article
12.
Moore FA, Haenel JB, Moore EE, Read RA.  Percutaneous tracheostomy/ gastrostomy in brain-injured patients: a minimally invasive alternative . J Trauma . 1992;33:435-439.Article
13.
Leinhardt DJ, Mughal M, Bowles B, Glew R, Kishen R, MacBeath J, Irving M.  Appraisal of percutaneous tracheostomy . Br J Surg . 1992;79:255-258.Article
14.
Friedman Y, Mayer AD.  Bedside percutaneous tracheostomy in critically ill patients . Chest . 1993;104:532-535.Article
15.
Earl PD, Lowry JC.  The percutaneous dilatational subcricoid tracheostomy . Br J Oral Maxillofac Surg . 1994;31:24-25.Article
16.
Toursarkissian B, Zweng TN, Kearney PA, Pofahl WE, Johnson SB, Barker DE.  Percutaneous dilatational tracheostomy: report of 141 cases . Ann Thorac Surg . 1994;57:862-867.Article
17.
Heffner JE.  Consensus conference on artificial airways in patients receiving mechanical ventilation: medical indications for tracheotomy . Chest . 1989;96: 186-190.Article
18.
Gaulkroger MC. Allt-Graham J.  Percutaneous dilatational tracheostomy . Br J Oral Maxillofac Surg . 1994;32:375-379.Article
19.
Marsh HM, Gillepsie DJ, Baumgartner AE.  Consensus conference on artificial airways in patients receiving mechanical ventilation: timing of tracheostomy in the critically ill patient . Chest . 1989;96:190-193.Article
20.
Stauffer JL, Olson DE, Petty TL.  Complications and consequences of endotracheal intubation and tracheostomy: a prospective study of 150 critically ill adult patients . Am J Med . 1981;70:65-76.Article
21.
Whited RE.  A prospective study of laryngotracheal sequelae in long-term intubation . Laryngoscope . 1984;94:367-377.Article
22.
Paul A, Marelli D, Chiu RC-J, Vestweber KH, Mulder DS.  Percutaneous endoscopic tracheostomy . Ann Thorac Surg . 1989;47:314-315.Article
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