Experience with 224 percutaneous dilatational tracheostomies at an adult intensive care unit in Bahrain: A descriptive study

Tracheostomy is one of the most commonly performed procedures in critically ill patients. Over the past 15 years, many large university hospitals have reported their experience with percutaneous dilatational tracheostomy (PDT). We have described and compared our experience with 224 PDTs that we performed in the last four and a half years. We have also compared PDT performed with and without bronchoscopic guidance at our setting and PDT verses surgical tracheostomy. OBJECTIVE: The purposes of this study are to evaluate the safety of PDT in our hospital setting and to compare our results with those published in the literature. DESIGN: A retrospective study for our experiences about safety and efficacy of 224 PDTs in an intensive care unit (ICU) setting. SETTING: A 11-bedded adult medical, surgical, neuro-trauma ICU at Salmaniya Medical Complex, Bahrain. MATERIALS AND METHODS: This is based on our experiences about complications/timings of all PDTs performed from October 2002 to February 2007. A retrospective chart analysis. RESULTS: There were 15 mechanical complications in total, including nine patients developing bleeding during or post-procedure, three patients developing pneumothorax and two patients developing cellulitis; in one procedure, a tracheostomy tube was misplaced. The proportion of total complications was 6.6% and no death. CONCLUSIONS: From our experience, bronchoscope can be used during PDTs performed in ICU by inexperienced intensivists who do not have good exposure to procedures, but after gaining adequate experience, PDT can be performed safely without using bronchoscope.