Early and late outcome of bedside percutaneous tracheostomy in the intensive care unit

To simplify long-term airway management in critically ill patients the feasibility of performing percutaneous tracheostomy (PT) in the intensive care unit (ICU) was investigated from August of 1997 to March of 2000. Bedside PT was considered for patients with positive end-expiratory pressure <10 cm H20, no previous tracheostomy, no anatomic distortion of the tracheal region, and no other indication to go to the operating room. Indication for tracheostomy, duration of endotracheal intubation, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, morbidity, and mortality were determined. Patients were prospectively followed until decannulation or for a minimum of 3 months. PT was performed in the ICU in 71 patients. Indications for PT were: acute respiratory failure (41), airway protection (26), and maxillofacial trauma (four). Mean duration of intubation before PT was 14 days (range 5-35 days). Average APACHE II score was 14 (range 3-28). Morbidity from PT included: early (two) and late (one) bleeding from the tracheostomy, early cuff leak (one), and self-decannulation (one). Sixteen patients died of causes unrelated to PT. Forty-five patients were decannulated after an average of 57 days (range 9-170 days); two noted a minor voice change. PT can be performed in the ICU with minimal morbidity eliminating the need for an operating room, the risks of patient transport, and the costs associated with each.