Is Fibreoptic Percutaneous Tracheostomy in ICU A Breakthrough

BACKGROUND: In ICUs, bedside percutaneous tracheostomy (pct) is commonly performed, but it is associated with certain drawbacks as paratracheal placement, posterior tracheal wall injury and tracheoesophageal fistula. To address these fibreoptic bronchoscope (FOB) guided PCT was introduced. We aimed to compare both these methods. PATIENTS & METHODS: We compared 60 age & sex matched patients into two groups of 30 each. In group 1 tracheostomy was performed by the conventional Ciaglia's method. In group 2, a fibreoptic bronchoscope was used in addition with the aid of an assistant. RESULTS: The fiberoptic method took more time than the conventional method. (18±3min vs 15±2min (p=0.001)). The average no. of attempts at insertion of needle was 2.4 in group 1 and 1.2 in group 2 (p=0.001). The fall in SpO2 to <90% was seen in 1 patient in group 1 and in 6 patients in group 2, so much so that the procedure had to be abandoned in 2 patients. CONCLUSION: FOB though definitely advantageous over CPCT in terms of lesser complications and being highly useful in the obese, short necked, and those with scar marks, is not without drawbacks such as requirement of additional staff and increased expenditure. The main being inability to be used in patients with low respiratory reserve. Overall it would be complimentary for any ICU to have FOB facility and must be used in select group of patients.