Journal des soins intensifs et critiques Libre accès

Abstrait

Percutaneous Tracheostomy without Bronchoscopy a Safe Procedure

Emídio Jorge Lima

Tracheostomy is a common procedure in ICU, particularly as an approach for weaning from mechanical ventilation. In mid-1980s percutaneous tracheostomy (PCT) was introduced as a less invasive alternative for the standard surgical tracheostomy. A tracheostomy facilitates weaning from mechanical ventilation, in long-term ventilated patients, by improving airway cleaning, better patient comfort and decreasing airway resistance. Prolonged mechanical ventilation has as main complication ventilator-associated pneumonia. In such case early tracheostomy may reduce that complication.

Methods: We analyzed prospectively 104 adult patients mean age of 53 years who underwent PCT at our ICU between 2012 and 2014. Inclusion criteria were: age>18 years and indication for tracheostomy. Exclusion criterion was technical contraindication for PCT. All the PCT were performed at bedside using Ciaglia technique. Results: 104 patients, reasons for PCT were weaning failures in 82 (78.85%) and airway protection in 22 (21.15%). The most frequently reasons for admission to the ICU were: pneumonia in 25 (24%), sepsis in 19 (18.3%), and drug intoxication in 7 (6.7%). The mean duration of preceding translaryngeal intubation was 9 days. The mean length of ICU stay was 14 days. We observed one complication in one patient; it was a tracheal stenosis. Sixty six patients (63%) died during their stay in the ICU. These deaths were unrelated to the PCT, but related to severe organ dysfunction. Thirty eight patients (36.54%) survived and was discharged from the hospital, 37 was decannulated.