PercuTwist-Dilatationstracheotomie

BACKGROUND: Percutaneous dilational tracheostomy (PDT) is considered to be an accepted method in intensive care patients. In 2002 Frova and Quintel described a method of dilation that employed controlled rotation of the PercuTwist dilational device. The goal of the present study was to evaluate the new technique employed by an experienced team. PATIENTS AND METHODS: Prospective, observational clinical study in 54 intensive care patients who required PDT. All tracheostomies were accompanied by bronchoscopic control. Vital parameters and perioperative complications were registered. RESULTS: In all 54 consecutive PercuTwist tracheostomies no severe complications were noted. Accidental tracheal ring fracture was noted in 7 patients while bleeding that needed surgical care occurred in 1 patient. CONCLUSION: The PercuTwist tracheostomy is a safe procedure for intensive care patients. More prospective studies that would compare the PercuTwist tracheostomy with the other PDT methods are necessary.     

Comparison of safety and cost of percutaneous versus surgical tracheostomy

Tracheostomy continues to be a standard procedure for the management of long-term ventilator-dependent patients. Traditionally the procedure has been performed by surgeons in the operating theater using an open technique. This routine practice has recently been challenged by the introduction of bedside percutaneous dilatational tracheostomy (PDT), which has been reported to be a cost-effective alternative. The purpose of this study is to evaluate and compare the safety, procedure time, cost, and utilization of percutaneous and surgical tracheostomies at a university hospital. A retrospective medical chart review was performed on all ventilator-dependent intensive care unit patients at the University of Virginia Medical Center undergoing tracheostomy during a 23-month period beginning December 26, 1996. Of the 213 patients identified for review, 74 and 139 patients received percutaneous and surgical tracheostomies, respectively. Of 74 percutaneous tracheostomies, 73 reviewed were performed by general surgeons, pulmonary physicians, or anesthesiologists in the intensive care unit; all open tracheostomies were performed by surgeons in the operating room, and one percutaneous procedure was performed in the operating room. Perioperative complications occurred in five of 74 patients (6.76%) during PDT; of these, three patients (4.1%) experienced major complications requiring emergent operative exploration of the neck. Three patients (2.2%) experienced perioperative complications during surgical tracheostomy. The mean procedure time was significantly shorter for the percutaneous procedure. Average charges per patient in an uncomplicated case including professional fees, inventory, bronchoscopy (if performed), and operating room charges were $1753.01 and $2604.00 for percutaneous and standard tracheostomies, respectively. These charges do not include the charges associated with surgical intervention after PDT complications. In contrast to previously published reports showing complications clustered during a physician's first 30 percutaneous cases, our study demonstrated no relationship between complication occurrence and physician experience. That is, no learning curve associated with performing PDT was evident. In addition there was no association seen between physician specialty and complication rate. PDT in the intensive care unit costs less than surgical tracheostomy performed in the operating room and can be performed in less time. Several other studies have recommended that bronchoscopy during PDT provides additional safety; however, in our series all three major complications took place during bronchoscopy-assisted percutaneous procedures. Our series suggests that PDT carries an appreciable risk of major complications. Careful patient selection and additional experience with the procedure may decrease complication rates to an acceptable level.     

Tracheostomy in cardiosurgical patients: surgical tracheostomy versus ciaglia and fantoni methods.

BACKGROUND: Patients requiring prolonged mechanical ventilation are not uncommon in a cardiosurgical intensive care unit. Elective tracheostomy is considered the airway treatment of choice in these patients. METHODS: To evaluate different techniques for tracheostomy, we prospectively investigated 120 patients who had conventional open (n = 40), minimally invasive percutaneous dilatational (n = 40), or translaryngeal (n = 40) tracheostomy techniques. The main areas of investigation included oxygenation index (partial pressure of arterial oxygen divided by fraction of inspired oxygen), complications, infection, and cost. RESULTS: The oxygenation index decreased in almost every patient, regardless of the technique used, but the extent of decrease was significantly lower in both minimally invasive techniques compared with the conventional method. Overall complication rate was 12.5% both in open tracheostomy and in percutaneous dilatational tracheostomy, whereas no complications occurred in translaryngeal tracheostomy procedures. Bacterial contamination of the tracheostomy site was found in 35% of the open tracheostomies, whereas no infection was seen in percutaneous dilatational or translaryngeal tracheostomies. In terms of costs, PDT ($506) and TLT ($362) were both much cheaper than open tracheostomy ($699). CONCLUSIONS: Percutaneous dilatational and translaryngeal tracheostomies are safe and cost-effective procedures that can be done easily at the patient's bedside and thus are attractive alternatives to conventional surgical tracheostomy in long-term airway access in a cardiosurgical intensive care unit.     

Management of and indications for tracheostomy in care of the critically ill patient

Tracheostomy is a procedure which has evolved over many hundreds of years. In the 21st century, the majority of tracheostomies are now inserted by intensivists in the intensive care unit (ICU). Commonly performed to assist in weaning patients from mechanical ventilation, the procedure is performed using a percutaneous dilatational technique (PDT). Percutaneous tracheostomy can generally be performed safely in ICU, although a number of contraindications and complications do exist. Recent publications have highlighted weaknesses in the quality of care both in the immediate and longer term. Consequently, a number of organizations, based in the UK and internationally, have turned the focus in recent years to improving the quality of care delivered to these patients. Clinicians caring for patients with tracheostomies should not only be familiar with the indications, anatomy and insertion techniques, but also current guidance on routine care and the emergency management of complications.     

Tracheostomies in burn patients.

The use of tracheostomies in burned patients with inhalation injuries is now reserved for specific indications rather than as prophylactic airway management. A 5-year burn center experience with tracheostomies used in this fashion is presented. Ninety-nine tracheostomies were performed in 3246 patients who had indications of prolonged respiratory failure or acute loss of airway. Although colonization of the sputum was universal, neither rates of pulmonary sepsis nor mortality were significantly increased in patients who underwent tracheostomies. Twenty-eight patients developed late upper airway sequelae, including tracheal stenosis (TS), tracheoesophageal fistula (TEF), and tracheoarterial fistula (TAF). Duration of intubation correlated only with development of TAF, whereas patients in whom TEF developed were significantly older and more likely to have evidence of tracheal necrosis at the time of tracheostomy. The pathogenesis of upper airway sequelae in these patients as divergent responses to the combined insults of inhalation injury, infection, and intubation is considered.     

Comparison of open, percutaneous, and translaryngeal tracheostomies.

INTRODUCTION: With 3 tracheostomy techniques currently available, controversy exists regarding which is safest and most economical. Percutaneous (PDT) and the new translaryngeal (TLT) tracheostomies are cited as more cost-effective than the traditional open surgical procedure because they are bedside techniques. Our objective was to compare the perioperative and postoperative complications of the 3 techniques.Study Design: This was a prospective trial involving 100 consecutive patients who underwent tracheostomy between April and December of 1997 at the London Health Sciences Centre and St Joseph's Health Centre in London, Canada. RESULTS: Fifty open tracheostomies were performed. Indications included prolonged ventilation (n = 42), airway protection (n = 5), pulmonary hygiene (n = 2), and sleep apnea (n = 1). A tension pneumothorax was the one significant intraoperative complication. Fifteen postoperative complications occurred, most notable of which was a 2-L hemorrhage at 24 hours. Thirty-seven TLTs were performed, 20 in patients with coagulopathy. Indications were prolonged intubation (n = 27), airway protection (n = 9), and pulmonary hygiene (n = 1). One intraoperative complication of accidental decannulation occurred. One postoperative complication, a pretracheal abscess, occurred in a decannulated transplant patient 2 weeks after the procedure. Thirteen PDTs were performed. Indications were prolonged intubation (n = 6), airway protection (n = 6), and tracheal toilet (n = 1). No significant complications occurred. CONCLUSIONS: TLT and PDT have fewer complications than the traditional open technique. TLT appears to have the greatest utility in the coagulopathic patient.     

Tracheostomy in children without heart disease

A series of 27 patients less than 15 years of age who had tracheostomies from 1968--1975 showed that only two of these patients had cardiac disease as the primary lesion. Only three pneumothoraces could be definitely attributed to the tracheostomy, while sepsis in two patients and pneumonia in one patient might possibly have been related to the tracheostomy itself. One death was due to the performance of the tracheostomy. In patients who have tracheostomy for noncardiac conditions, performance of the tracheostomy in the operating room with an endotracheal tube in place, the use of plastic or silastic body contour conforming tubes, and proper intensive care nursing immediately after tracheostomy have reduced complications to a minimum and made the performance of tracheostomy in this age group a safe and effective procedure when oro- or nasotracheal intubation is inadequate.     

Chest radiographs after dilatational percutaneous tracheotomy: are they necessary?

BACKGROUND: The efficacy of routinely obtaining chest radiographs after standard open tracheotomy has been questioned. Recent literature would suggest that after a routine, uncomplicated tracheotomy, chest radiography is a low-yield procedure that incurs unnecessary expense. Percutaneous dilatational tracheotomy (PDT) is rapidly replacing open tracheotomy as the intensive care unit procedure of choice for airway management. Complication rates are equivalent between the two procedures. OBJECTIVE: We examined the value and cost-effectiveness of routine postoperative chest radiographs in patients undergoing PDT. Study Design and Setting: The study was a prospective analysis of 54 consecutive PDTs performed at a tertiary care academic institution. RESULTS: Eighteen (33%) patients had chest radiographs obtained within 1 hour of PDT (6 at the request of the otolaryngology service); 35 (66%) underwent radiography more than 2 hours later at the request of the intensive care unit for reasons other than PDT. There were no incidents of pneumothorax, pneumomediastinum, or tracheotomy tube malposition in any patient. Patients undergoing chest radiography within 1 hour of the PDT also had chest radiographs within 12 hours at the request of ICU staff for their underlying disease. CONCLUSIONS: Routine chest radiography after PDT is of low yield. Because most of these patients require chest radiographs for their underlying disease within 12 hours, a cost savings of approximately $13,500 would be realized in this patient population. SIGNIFICANCE: Routine chest radiography after PDT is unwarranted in most cases.     

Percutaneous dilatational tracheostomy is as safe as open tracheostomy

Although percutaneous dilatational tracheostomy (PDT) has been advocated as an alternative to open tracheostomy (OT) its relative safety has been questioned repeatedly. This study prospectively compared the safety and complications of PDT and OT. Ninety-four patients underwent PDT and 252 patients underwent OT at this institution from December 1998 through April 2000 with the choice of procedure left to the operator. OT was performed in the operating room whereas PDT was performed in intensive care units (ICUs). PDT was performed by surgeons and medical intensivists under a strict institutional policy and procedure governing patient selection and conduct of the procedure. Complications were defined as bleeding, loss of airway, hypotension, hypoxia, tracheostomy tube malposition, subcutaneous emphysema, infection, and conversion of PDT to OT. All patients survived the operation. PDT and OT had similar complication rates: 2.1 per cent for PDT versus 2.8 per cent for OT (P = not significant). Postoperative bleeding, which was the most frequent complication, occurred in one PDT patient and four OT patients. One PDT patient required conversion to OT as a result of extensive tracheal fibrosis. Subcutaneous emphysema, soft-tissue infection, and a malpositioned tracheostomy tube were the remaining complications in the OT patients. We conclude that the complication rates of PDT and OT are comparable. The choice of PDT or OT should be dictated by the surgeon's training and experience, the patient's condition, neck anatomy, and stability for transfer to the operating room.     

Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical review

Tracheo-innominate artery fistula (TIF) is an uncommon yet lifethreatening complication after a tracheostomy. Rates of 0.1–1%after surgical tracheostomy have been reported, with a peakincidence at 7–14 days post procedure. It is usually fatalunless treatment is instituted immediately. Initial case reportsof TIF resulted from surgically performed tracheostomies. Wepresent three fatalities attributable to TIF, confirmed by histopathology,after percutaneous dilatational tracheostomy (PDT). The useof PDT has resulted in tracheostomies being performed by specialistsfrom different backgrounds and the incidence of this complicationmay be increasing. Pressure necrosis from high cuff pressure,mucosal trauma from malpositioned cannula tip, low trachealincision, radiotherapy and prolonged intubation are all implicatedin TIF formation. Massive haemorrhage occurring 3 days to 6weeks after tracheostomy is a result of TIF until proven otherwise.We present a simple algorithm for management of this situation.The manoeuvres outlined will control bleeding in more than 80%of patients by a direct tamponade effect. Surgical stasis isobtained by debriding the innominate artery proximally, thentransecting and closing the lumen. Neurological sequelae arefew. Post-mortem diagnosis of TIF may be difficult, but specificpathology request should be made to assess innominate arteryabnormalities.     

Weaning from ventilator after cardiac operation using the Ciaglia percutaneous tracheostomy.

OBJECTIVE: To determine the predictors of weaning from mechanical ventilation after cardiac operation with the Ciaglia percutaneous dilatational tracheostomy (PDT) in our preliminary experience in the use of this technique. METHODS: We prospectively analysed 33 consecutive patients (mean age 70.9+/-12.7 years) who underwent PDT in our intensive care unit after cardiac operation. The investigation involved preoperative and postoperative clinical status, operative procedure, indication and timing for PDT. RESULTS: PDT was performed after a mean time of 7.7+/-5.0 consecutive days of translaryngeal intubation. Twenty-four (73%) patients were weaned from ventilator after a mean time of mechanical ventilation of 15.8+/-9.1 days. Time point of PDT was the only predictor of ventilator weaning (P=0.0029): there was significant association between PDT performed before the seventh consecutive day of translaryngeal intubation (early PDT) and successful weaning from ventilator (P=0.01; odds ratio=11.2, 95% confidence interval=1.2-104.3). Among the patients weaned from ventilator, those who underwent early PDT had significantly shorter times of mechanical ventilation, and intensive care unit and hospital stays than patients with later PDT (P=0.035, 0.011 and 0.0073, respectively). Nine (27%) patients died of their underlying disease while still being mechanically ventilated; another six (18%) spontaneously breathing but still incannulated patients died afterward. No major PDT-related complications were observed. Two minor peristomal bleedings and one self-resolving subcutaneous emphysema were recorded. CONCLUSIONS: Early PDT was a safe and effective method to wean from mechanical ventilation the cardiosurgical patients of this series.     

Use of the Combitube for airway maintenance during percutaneous dilatational tracheostomy

The Combitube airway allows short-term ventilation during cardiopulmonary resuscitation and can be useful in the management of the difficult airway. In a prospective observational study we assessed its use during percutaneous dilatational tracheostomy (PDT). Twenty-one intensive care patients scheduled for elective PDT had their tracheal tube replaced by a Combitube airway retaining the same ventilator settings. Arterial blood gases, airway pressures, SpO₂ and end-tidal CO₂ were measured as were the transmural pressures exerted by the Combitube cuffs. Combitube placement was successful in 20 of 21 patients although adequate ventilation was possible in only 17 (85%). There was no significant change in P a O ₂, S p O ₂, end-tidal CO₂, P a CO ₂ or mean airway pressure during Combitube ventilation. A high mean (SD) transmural pressure of 14.7 (5) kPa was exerted by the distal cuff. The Combitube provided a satisfactory alternative airway to the tracheal tube during performance of PDT in 85% of our patients. Potential problems associated with its use in intensive care patients are outlined.     

Cricoid Palpability as a Selection Criterion for Bedside Tracheostomy

OBJECTIVE: To prospectively evaluate the significance of cricoid cartilage palpability as a selection criterion for bedside tracheostomy and to prospectively compare a cohort of patients undergoing bedside tracheostomy with another cohort receiving operating room tracheostomy. STUDY DESIGN/SETTING: Prospective trial comparing 2 cohorts of patients receiving tracheostomies at a tertiary care center (university hospital). In all, 220 consecutive intubated patients selected for elective tracheostomy were enrolled. Of them, 134 patients had palpable cricoid cartilage and underwent open surgical tracheostomy at the bedside. The remaining 68 patients received open surgical tracheostomies in the operating room. Demographic data, patient anatomic features, and perioperative complications were prospectively recorded. There were no statistically significant differences in age, gender, reason for admission, indication for tracheostomy, Acute Physiology and Chronic Health Evaluation II score, number of days intubated, or time required to perform the procedure for those patients whose tracheostomies were performed in the operating room versus the intensive care unit. RESULTS: Patients with a palpable cricoid cartilage had a significantly reduced perioperative complication rate compared with those without a palpable cricoid cartilage (2% vs 22%, P < 0.001). Comparison of cervical girth, mental-to-sternum distance, and thyroid-notch-to-sternum distance showed no significant difference between the 2 groups and did not further define selection criteria. CONCLUSION: This investigation prospectively confirms the safety of bedside tracheostomy placement in properly selected patients. Complication incidences are defined for open surgical tracheostomy at the bedside and in the operating room. Palpability of the cricoid cartilage has significant value as a selection criterion for bedside tracheostomy. SIGNIFICANCE: These findings will aid in the development of protocols and pathways for surgical airway management in critically ill patients to maximize cost-effective, high-quality care.     

Airway management of patients undergoing oral cancer surgery: a retrospective study

OBJECTIVE: This retrospective study aims to describe the airway management and benefits of nasotracheal intubation over tracheostomy in 260 patients with oral cancer undergoing surgery. METHODS AND RESULTS: The medical records of 260 patients undergoing surgery for oral cancer were reviewed for airway management during the perioperative period. Eighteen patients had previous surgery for oral cancer and were scheduled for flap reconstruction, recurrence or other complications. In 28 cases neck movement was restricted and decreased mouth opening was found in 50% of all patients because of a large growth or fixation of tissues of head and neck, oral cavity, pharynx or larynx by tumour, or radiation fibrosis. In 53 patients intubation was undertaken under spontaneous ventilation. In 20 cases the trachea was extubated in the immediate postoperative period. In 220 cases patients were extubated next morning in the intensive care unit. In none of the cases was elective tracheostomy under local anaesthesia performed before surgery for the maintenance of the airway for anaesthesia. Elective tracheostomies were done in 17 cases. Three patients remained intubated for 24-48 h because of a high suspicion of airway obstruction following extubation due to a large pectoralis major flap. These three patients received a tracheostomy because of increased oropharyngeal and laryngeal oedema. In three cases emergency tracheostomies were performed due to upper airway obstruction after extubation and in one case prolonged elective ventilation was required due to severe chest infection. CONCLUSION: Oral cancer patients have a potentially difficult airway but, if managed properly during perioperative period, morbidity and mortality can be reduced or avoided. Oral cancer patients can be managed safely without the routine use of a tracheostomy. Nasotracheal intubation is a safe alternative to tracheostomy in oral cancer patients except in some selected patients.     

Percutaneous dilation tracheotomy versus surgical tracheotomy: our experience.

BACKGROUND: Percutaneous dilation tracheotomy (PDT) is becoming a popular alternative to surgical tracheotomy. In our department, we recently adopted the use of the PDT in intensive care unit patients. Here, we compare the results of the use of these 2 techniques on 150 patients, all performed by the same surgeon. We discuss the pros and cons of PDT and present our experience with the technique compared with surgical tracheotomy (ST). MATERIALS AND METHODS: A prospective study of 75 PDTs and a retrospective study of 75 surgical tracheotomies (ST) were performed at the Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center, Haifa, Israel. Age, sex, duration of intubation before surgery, time interval between the decision to perform and the performance of tracheotomy, and cost were compared. RESULTS: One hundred fifty tracheotomies were reviewed. The indication for tracheotomy in both groups was prolonged mechanical ventilation. Seven patients were found unsuitable for PDT and underwent ST. Complications included 3 cases of mild postoperative hemorrhage in the ST group, and 1 case of subcutaneous emphysema, 1 case of stomal cellulitis and 2 cases of mild postoperative hemorrhage in the PDT group. The average waiting interval was between 2 to 5 days for ST and 1 to 24 hours for PDT. The intraoperative time for ST was 20 minutes; for PDT, 5 minutes. The cost was 565 dollars for ST and 274 dollars for PDT. CONCLUSIONS: PTD provides an easy, less expensive, and convenient alternative to ST and should be added to the otolaryngologists' armamentarium of surgical airway procedures. The procedure is advantageous for the patient. Complication rates of both techniques are similar and low; however, PDT is a blind technique of obtaining a surgical airway and therefore holds more potential for serious complications. It is our conclusion that this technique is suitable for many, but not all, critical care patients and that the procedure should be performed only by surgeons who are capable of urgently obtaining a surgical airway or exploring the neck should the PDT fail.     

Percutaneous dilational tracheotomy in solid-organ transplant recipients

Pulmonary complications, such as pneumonia and respiratory failure, are important contributors to posttransplantation morbidity and mortality among solid-organ transplant recipients. Percutaneous dilational tracheotomy (PDT) is cost-effective in critically ill patients who require prolonged mechanical ventilation; however, the literature lacks reports about the effectiveness of this procedure in organ transplant recipients. Between August 2001 and February 2003, five recipients underwent PDT in our intensive care unit: two kidney, two liver, and one heart transplant recipient. The respective mean values for age, weight and APACHE II score were 41 +/- 7 yrs (range, 33-51 years), 63 +/- 14 kg (range, 40-80 kg), and 23 +/- 9 (range, 15-35). All PDTs were performed at the bedside by an experienced staff anesthesiologist under endoscopic guidance using the Griggs forceps dilational technique. The mean interval from transplantation to PDT was 58 +/- 56 months (range, 8 days to 132 months). In all cases, the indication for PDT was prolonged mechanical ventilation due to acute respiratory failure. The mean duration of endotracheal intubation before PDT was 4 +/- 3 days (range, 1-8 days). Transient hypoxemia (n = 1) and mild extratracheal bleeding (n = 1) were the only early complications. There were no late complications (including peristomal infection) or deaths associated with the procedures. Among the two patients who survived their stay in the intensive care unit, the functional and cosmetic outcomes of PDT were excellent. We recommend this technique for prolonged airway management in solid-organ transplant recipients.     

Management of and indications for tracheostomy in care of the critically ill patient

Tracheostomy is a procedure that has evolved over many hundreds of years. In the 21st century, the majority of tracheostomies are now inserted by intensivists in the intensive care unit (ICU). Commonly performed to assist in weaning patients from mechanical ventilation, the procedure is performed using a percutaneous dilatational technique. Percutaneous tracheostomy can generally be performed safely in the ICU, although a number of contra-indications and complications do exist. Recent publications have highlighted weaknesses in the quality of care both in the immediate and longer term. Consequently, a number of organizations, based in the UK and internationally, have turned the focus in recent years to improving the quality of care delivered to these patients. Clinicians caring for patients with tracheostomies should not only be familiar with the indications, anatomy and insertion techniques, but also current guidance on routine care and the emergency management of complications.     

Ultrasound-guided percutaneous dilatational tracheostomy with laryngeal mask airway control in a morbidly obese patient

Percutaneous dilatational tracheostomy (PDT) is a widely used and accepted method of long-term ventilation of critically ill patients in many intensive care units. However, it has certain contraindications that must be taken into account; for example, difficult anatomy and short, bull neck that are so often seen in morbidly obese persons. We present a case of a morbidly obese female patient in whom ultrasound-guided PDT was performed and in whom the airway was controlled by Laryngeal Mask Airway (LMA) during the procedure. Possible advantages of an ultrasonography-guided method and LMA control in morbidly obese patients also are discussed.     

Bronchoscopy in the critically ill surgical patient

Sixty-seven bronchoscopic examinations were performed in a busy surgical intensive care unit on 51 patients, and the techniques, morbidity, and outcome were prospectively analyzed to assess the efficacy and safety of the procedure in this particular patient population. General surgical trauma, cardiothoracic, and orthopedic patients were included. Fifty-three (79%) procedures were performed with the flexible instrument, while 14 patients (21%) underwent rigid endoscopy. Forty-six patients were being mechanically ventilated; 30 had endotracheal tubes, and 16 had tracheostomies. Suspected lobar collapse (60%), persistent pulmonary infiltrates (3%), suspected aspiration (21%), and suspicion of airway trauma (12%) were the primary clinical indications for bronchoscopy. No deaths occurred. Complications were seen in 16 per cent of the procedures and 17 per cent of the patients. There were arrhythmias (other than sinus tachycardia) in seven procedures (11%) and one episode each of hypertension, self-limited endobronchial bleeding, mediastinal emphysema, and increased intracranial pressure. Significant improvement was demonstrated for patients with lobar collapse but not for those with mild atelectasis or pulmonary infiltrates on radiographs taken within 24 hours. Overall, 39 patients (58%) improved radiographically, while 38 patients (42%) did not. Differences in arterial PO2 measured before and after bronchoscopy between groups ventilated with an FiO2 of 1.0, and those who were not did not achieve statistical significance (P less than 0.05).     

The effect of tracheostomy on outcome in intensive care unit patients

BACKGROUND: Percutaneous dilatation tracheostomy (PDT) is increasingly being used in the intensive care unit (ICU), and has probably increased the number of procedures performed. The primary aim of this study was to document the short- and long-term outcome of patients with a tracheostomy performed during an ICU stay. METHODS: Patients in our ICU who underwent an unplanned tracheostomy between 1997 and 2003 were included in this analysis. The type of tracheostomy (PDT or surgical tracheostomy) and time of the procedure were registered prospectively in our ICU database. Survival was followed using the People's Registry of Norway and morbidity data from the individual hospital record. These patients were also compared with a group of ICU patients ventilated for more than 24 h, but managed without a tracheostomy. We also compared patients who had early tracheostomy (less than median time to procedure) with those who had late tracheostomy. RESULTS: Of the 2844 admissions (2581 patients), unplanned tracheostomy was performed during 461 admissions (16.2%) on 454 patients (17.6%). The median time to tracheostomy was 6 days. The ICU, hospital and 1-year mortality rates were 10.8, 27.1 and 37.2%, respectively, significantly less than those of the group ventilated without tracheostomy. The median time to decannulation was 14 days. Patients who had early tracheostomy had a more favourable long-term survival than those who had late tracheostomy. No procedure-related mortality was registered. CONCLUSIONS: In our ICU, having a tracheostomy performed was associated with a favourable long-term outcome with regard to survival, and early tracheostomy improved survival in addition to consuming less ICU resources.