Early and Late Complications After Elective Bedside Surgical Tracheostomy: Our Experience

Francesco Imperatore, MD, PhD, TPM; Francesco Diurno, MD; Tito Passannanti, MD; Giovanni Liguori, MD; Nicola d'Ignazio, MD; Paolo Marsilia, MD; Francesco Munciello, MD; Luigi Occhiochiuso, MD

In This Article

Abstract and Introduction

Objective: The aim of this study is to present our experience with elective surgical tracheostomy (ST) performed at the intensive care unit (ICU) bedside in order to evaluate its efficacy in terms of safety and intraoperative and postoperative complications.
Design: Prospective, nonrandomized, noncomparative study.
Setting: Medical, surgical, and intensive care unit of the largest nonteaching hospital in Southern Italy.
Patients and Participants: The study included a total of 140 consecutive ICU patients requiring tracheostomy. All tracheostomies were performed by ICU staff physicians at patients' bedsides.
Intervention: The following data were recorded: age, sex, Simplified Acute Physiology Score (SAPS) II, fraction of inspired oxygen (FIO2) before the tracheostomy, days on mechanical ventilation before the tracheostomy, bleeding, tracheal tear, subcutaneous emphysema, pneumothorax, wound infection, hypotension, lowering SaO2 during the procedure, inability to complete the procedure, and procedural mortality. Distance follow-up included fiberoptic bronchoscopy to evaluate tracheal stenosis.
Measurement and Results: There were a total of 8 (5.71%) complications. Hemorrhage, wound infection, and tracheal stenosis were present in 3 (2.14%), 4 (2.85%), and 1 (0.71%) patients, respectively. Sixty-one patients died in the ICU (43.57%), although none of these deaths were related to technique complications. Mean duration of the procedure was 12.5 ± 0.2 minutes.
Conclusions: The ST performed at bedside in the ICU is a simple and safe procedure that offers many advantages in terms of safety and efficacy.

Tracheostomy is one of the oldest surgical procedures and, over the past few decades, has become the method of choice in the management of patients requiring long-term mechanical ventilation.[1]

Tracheostomy is a frequently performed procedure and historically has had a high complication rate. This has led some authors to suggest that a tracheostomy should be done only in the operating room (OR).[2]

Although the standard tracheostomy described in 1909 by Jackson[1] has been extensively used in critically ill patients, a more simple procedure that can be performed at the bedside is needed in order to reduce the high rate of complications and to avoid the risks associated with the transport of the patient to the OR. Since 1957, several different types of percutaneous tracheostomy (PT) techniques performed at the bedside have been described, including percutaneous dilatational techniques.[3,4,5]

Recently, bedside tracheostomy in the ICU has been shown to be safe, but this concept has not been widely accepted. Concerns regarding the hazards of transporting critically ill patients to the OR may inhibit the use of tracheostomy.

Randomized studies have demonstrated that experienced intensivists can perform bedside STs with lower risk and cost when compared with bedside PTs.[6]

The aim of this prospective, noncomparative study is to present early and late complications after ST, performed at the bedside by experienced ICU medical staff, over a 2-year period.