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Objective: This study aimed to assess the safety and efficacy of endoscopic percutaneous dilatational tracheostomy (PDT) in obese and nonobese critically ill adults. Methods: A retrospective study of all cases of PDT performed at two academic health centers between 2016 and 2023 was conducted. Primary outcomes included peri‐ and postoperative complications stratified by both timing and severity. body mass index (BMI) data were stratified according to the World Health Organization classification (class I obesity defined as BMI ≥ 30, class II obesity ≥35 and <40, class 3 obesity ≥40). Results: Totally 336 patients underwent a PDT, 279 of whom had available BMI data: 193 (69.2%) patients had a normal BMI, 56 (20.1%) had class I obesity, 15 (5.4%) class II obesity, and 15 (5.4%) class III obesity. The overall complication rates for the class I, II, and III obesity were 8.9%, 13.3%, and 13.3%, respectively. All procedures were successfully completed at the bedside (no conversions to an open approach), and there was no procedure‐related mortality. The only accidental decannulation event was in a patient with class III obesity. There was no difference in overall complication rates between patients without obesity and patients with obesity (7.3% vs. 10.5%, respectively, p = 0.370). Conclusion: This study significantly expands the current literature and represents one of the largest studies to date reporting on PDT in patients with obesity. Level of Evidence: 3 Laryngoscope, 134:5015–5020, 2024 [ABSTRACT FROM AUTHOR]

Background and Objectives: Tracheostomy is a commonly performed procedure in critically ill patients requiring prolonged mechanical ventilation due to airway issues resulting from neurological, respiratory, and infectious diseases. This study aimed to compare the outcomes of percutaneous dilatational tracheostomy (PDT) with surgical tracheostomy (ST) in patients admitted to the emergency medical ward and requiring prolonged mechanical ventilation. The objectives were to evaluate and compare the two techniques, with respect to turnaround time, procedural time, incidence of surgical site infection, procedure-related bleeding, ventilator-associated pneumonia (VAP), and mortality. Methods: This prospective cohort study was conducted at the Division of Acute Care and Emergency Medicine, and the Department of Otolaryngology, Head and Neck Surgery, at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. We enrolled adult patients (over 18 years), who required tracheostomy for long-term airway management (beyond 14 days). The patients were assigned to either the PDT or ST group by the attending physician. PDT was done at the bedside by emergency physicians using the Portex ULTRAperc single-stage dilator kit. ST was performed in the operating room by otolaryngology surgeons. Patients were followed up for 3 months, and efficacy and safety outcomes were compared between the two groups using Mann–Whitney U-test for nonparametric continuous data, while Chi-squared and Fisher’s exact tests were used for comparison of categorical data. Results: A total of 50 patients were enrolled in the study, with 25 patients each in the PDT and ST groups. The age and sex distribution, baseline Glasgow Coma Score, Sequential Organ Failure Assessment Score, indications for intubation, and comorbidities did not differ significantly between the two groups. The median (interquartile range [IQR]) turnaround time for PDT was 1 (1–1) day, significantly shorter than the 3 (2–4) days for ST (P < 0.001). Furthermore, the median (IQR) procedural time for PDT was 5 (4–6) min, significantly shorter than the 12 (10–14) min for ST (P < 0.001). PDT exhibited a lower rate of surgical site infections (n = 7) (28%) compared to ST (n = 15) (60%) (P = 0.023). Although the PDT group had two incidents of hemorrhage (n = 2) (8.0%), the difference compared to the ST group (n = 0) (0%) was not statistically significant (P = 0.49). The PDT group was comparable to the ST group with regard to incidence of VAP (13 vs. 13, P = 1.00) and 90-day mortality (14 vs. 15, P = 0.77). Conclusions: In critically ill patients requiring prolonged mechanical ventilation, the advantages of PDT included reduced turnaround and procedural times, as well as a significantly lower rate of surgical site infections. While PDT showed a slightly higher incidence of hemorrhage, both the PDT and ST groups had a similar incidence of VAP and mortality.

Background: Individual implementation rate of bronchoscopy-guided percutaneous dilatational tracheostomy (PDT) varies among intensivists. Simulation training (ST) can increase the safety of medical procedures by reducing stress levels of the performing team. The aim of this study was to evaluate the benefit of ST in PDT regarding procedural time, quality of performance, and percepted feelings of safety of the proceduralist and to compare conventional simulators (CSIM) with simulators generated from 3D printers (3DSIM). Methods: We conducted a prospective, single-center, randomized, blinded cross-over study comparing the benefit of CSIM versus 3DSIM for ST of PDT. Participants underwent a standardized theoretical training and were randomized to ST with CSIM (group A) or 3DSIM (group B). After ST, participants' performance was assessed by two blinded examiners on a porcine trachea regarding time required for successful completion of PDT and correct performance (assessed by a performance score). Percepted feelings of safety were assessed before and after ST. This was followed by a second training and second assessment of the same aspects with crossed groups. Results: 44 participants were included: 24 initially trained with CSIM (group A) and 20 with 3DSIM (group B). Correctness of the PDT performance increased significantly in group B (p <.01) and not significantly in group A (p =.14). Mean procedural time required for performing a PDT after their second ST compared to the first assessment (p <.01) was lower with no difference between group A and group B and irrespective of the participants' previous experience regarding PDT, age, and sex. Moreover, percepted feelings of safety increased after the first ST in both groups (p <.001). Conclusions: ST can improve procedural skills, procedural time, and percepted feelings of safety of the proceduralist in simulated PDT. [ABSTRACT FROM AUTHOR]

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Objective: Percutaneous dilatational tracheostomy is more comfortable and convenient for the patient in need of prolonged mechanical ventilation in intensive care units. During the procedure, retraction of the endotracheal tube and ventilation with a laryngeal mask are used to ensure airway safety. In our study, we aimed to find the efficacy and safety of these two techniques. Design: Our study was performed in patients in whom tracheostomy was planned due to the need for prolonged mechanical ventilation in the adult intensive care unit of Bolu Izzet Baysal State Hospital. Ethics committee permission was obtained. Place & duration of study: Our study was conducted in patients who underwent PDT between 01 April 2023 and 31 August 2023 in Izzet Baysal State Hospital. Materials and metohds: Demographic data of the patients were recorded. Anaesthesia preferences, duration of the procedure, blood tests, status of airway equipment renewal, complication status and mortality were recorded prospectively. Results: A total of 53 patients, 23 of whom were female, were included in the study. Twenty-six patients who underwent the procedure by retracting the endotracheal tube assigned as group 1 and 27 patients who underwent laryngeal mask were assigned as group 2. The most common comorbidity was neurological disorder with 33 patients (62.3%). There was no difference between the two groups in terms of blood tests, arterial blood gas analyses, propofol dose, mortality and development of complications. Group 1 required more rocuronium and reintubation, and the duration of the procedure was significantly longer. Conclusion: There is no difference in mortality and complication development between percutaneous dilatational tracheostomy using laryngeal mask and endotracheal tube. The use of laryngeal mask is safe and effective, especially in intensive care units with fewer staff. [ABSTRACT FROM AUTHOR]

Background: Percutaneous dilatational tracheostomy (PDT) is the most commonly performed minimally invasive intensive care unit procedure worldwide. Methods: This study evaluated the percentage of consistency between the entry site observed with fiberoptic bronchoscopy (FOB) and the prediction for the PDT level based on pre-procedural ultrasonography (USG) in PDT procedures performed using the forceps dilatation method. The effect of morphological features on intervention sites was also investigated. Complications that occurred during and after the procedure, as well as the duration, site, and quantity of the procedures, were recorded. Results: Data obtained from a total of 91 patients were analyzed. In 57 patients (62.6%), the USG-estimated tracheal puncture level was consistent with the intercartilaginous space observed by FOB, while in 34 patients (37.4%), there was a discrepancy between these two methods. According to Bland Altman, the agreement between the tracheal spaces determined by USG and FOB was close. Regression formulas for PDT procedures defining the intercartilaginous puncture level based on morphologic measurements of the patients were created. The most common complication related to PDT was cartilage fracture (17.6%), which was proven to be predicted with maximum relevance by punctured tracheal level, neck extension limitation, and procedure duration. Conclusions: In PDT procedures using the forceps dilatation method, the prediction of the PDT intervention level based on pre-procedural USG was considerably in accordance with the entry site observed by FOB. The intercartilaginous puncture level could be estimated based on morphological measurements. [ABSTRACT FROM AUTHOR]

Aim:Preprocedural ultrasonographic examination of the upper airway anatomy is an effective method for deciding on a tracheostomy procedure, such as percutaneous or surgical tracheostomy. We aimed to compare the effects of superficial cervical plexus block (CPB) with translaryngeal block with those of local anesthesia infiltration to the incision site for percutaneous tracheostomy in terms of hemodynamic parameters, gag reflex, and anesthetic requirement. In addition, we evaluated the effect of preprocedural ultrasonography assessment compared with that of anatomical landmark examination in terms of reducing the risk of procedure-related complications.Materials and Methods:A total of 148 patients aged at the range of 18-99 years, who were indicated for percutaneous tracheostomy in the intensive care unit, were enrolled in the study. The data intended for this study were obtained from the hospital’s electronic patient database through retrospective scanning between 2018 and 2022. Patients who underwent ultrasonography for the evaluation of the related anatomical structures and superficial CPB with a translaryngeal block were assigned to the ultrasonography group (n=74), whereas those who underwent an anatomical landmark technique and local anesthetic infiltration to the procedure site were assigned to the traditional group (n=74).Results:The patients’ age and sex distributions did not differ significantly between the traditional and ultrasonography groups (p>0.05). In the ultrasonography group, the preprocedural, midprocedural, and postprocedural heart rates were significantly higher than in the traditional group (p

Percutaneous dilatational tracheostomy (PDT) is a more popular option than open tracheostomy in adults. However, in the pediatric population, it is more uncommonly done due to a narrower, more malleable trachea and a smaller surgical site, which increases difficulties. Hereby, we present cases of children treated by PDT. In our case series, four children received bedside PDT in the pediatric intensive care unit. Endotracheal tube position, puncture site, and tracheal cannula size were all identified using ultrasound (US). PDT procedures were guided by flexible bronchoscopy-guided. There were no complications observed following the processes. PDT is a safe method that can be used as an alternative to surgical tracheostomy in children and is further enhanced by US and bronchoscopy-guided.

OBJECTIVE: Percutaneous dilatational tracheostomy (PDT) is a bedside applicable procedure in intensive care unit patients requiring long-term mechanical ventilation. Fiber optic bronchoscopy (FOB) makes it easier and reduces complications. Our study aimed to evaluate the indications, complications, and prognosis of PDTs performed with FOB. PATIENTS AND METHODS: Our study included 114 patients undergoing PDT through FOB-guided Griggs method in the Respiratory Intensive Care Unit between January 01, 2018, and January 31, 2023. RESULTS: Among the patients undergoing PDT with FOB, 81 (71.1%) were male. The mean age was 62.1±11.5. The median Glasgow Coma Scale (GCS) score was 9, the median Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score was 19, and the median Sequential Organ Failure Assessment (SOFA) score was 8. Tracheostomy was opened for prolonged mechanical-ventilator requirement in 80 patients (70.2%), to protect the airway in 19 (16.7%), and for poor neurologic status in 15 patients (13.2%). Complications during the procedure included hypoxemia in 3 patients (2.6%), minor bleeding in 3 patients (2.6%), perforation of the FOB in one patient (0.8%), and perforation of the intubation tube cuff in one patient (0.8%). 79 patients (69.3%) were discharged, and 35 (30.7%) were exited. There was a significant difference between the GCS, APACHE-II, and SOFA scores of the patients discharged and those who exited (p < 0.001). CONCLUSIONS: FOB-guided PDT application should be encouraged as it reduces complications but it is still limited because it requires experienced specialists and equipment for a standard approach. [ABSTRACT FROM AUTHOR]

This autopsy case involved a woman in her 60 s with a history of temporal tracheostomy. During an event in which her son allegedly experienced an epileptic seizure, he grasped the woman around the upper chest for several moments. The woman then experienced breathing difficulties, lost consciousness and died. Postmortem computed tomography revealed a pinhole-like tracheal narrowing at the level of the tracheostomy encircled by the thyroid. Autopsy revealed a modestly enlarged thyroid gland due to previously undiagnosed Hashimoto's disease and an old fracture in a tracheal ring indicating that the trachea had been compressed by the thyroid. Hashimoto's disease rarely causes sudden death through systemic endocrine disturbance, but this case may illustrate that against a background of previous tracheostomy that mechanically weakens the trachea, enlargement of the thyroid (goiter) as a local effect of the disease can also cause sudden death.

Purpose: Percutaneous dilatational tracheostomy (PDT) is widely used in mechanical ventilation patients to facilitate weaning. This modified technique aims to reduce accidental intraprocedural airway loss and desaturation associated with current PDT techniques. Materials and Methods: This is a single-center, prospective cohort study of 100 patients who underwent a modified technique between September 8, 2022, and January 18, 2023. The procedure was performed at Shiraz University of medical science at the tertiary center, Namazi teaching hospital. In this method instead of withdrawing the endotracheal tube (ETT) up close to the vocal cord and subglottic area at the beginning of the procedure, which is a common theme in PDT techniques with accidental extubation risk, we kept the ETT and gradually withdraw it. Results: Of the 100 patients, the average age was 53.5 years, and 66% were males. On average, the procedure lasted 255 (67) seconds. All patients successfully underwent PDT with no life-threatening complications, accidental intraprocedural airway loss, or desaturation. Conclusions: As a result of this modified technique, PDT for airway management can be a safe and low-complication procedure without the risk of accidental intraprocedural airway loss. Moreover, omitting bronchoscopy and sonography during these procedures is cost-effective and secure. [ABSTRACT FROM AUTHOR]

Background: Current practices regarding percutaneous dilatational tracheostomy in adult patients treated with extracorporeal membrane oxygenation (ECMO) after cardiac surgery is not completely defined. This study aimed to evaluate the safety of the percutaneous dilatational tracheostomy in patients with ECMO after cardiac surgery. Methods: Between July 2017 and May 2021, 371 ECMO procedures were performed in more than 35,000 adult patients who underwent cardiac surgery in our hospital. Sixty-two patients underwent percutaneous dilatational tracheostomy (PDT) during or after ECMO. A retrospective analysis was performed comparing the incidence of complications and clinical outcomes of the two groups. Results: Of the 371 patients treated with ECMO after adult cardiac surgery during the enrollment period, 22 (7.1%) and 40 (12.8%) underwent PDT during or after ECMO, respectively. The platelet count (PLT) of the day was significantly lower in the PDT during ECMO group (54 (34, 68) vs. 108 (69, 162) (thousands), p < 0.001)). The prothrombin time (PT) and activated partial thromboplastin time (APTT) of the day were longer in the PDT during ECMO group (15.8 (14.6, 19.9) vs. 13.8 (13.2, 15.2) seconds, p = 0.001, 43.8 (38.0, 49.4) vs. 35.2 (28.2, 40.9) seconds, p < 0.001, respectively). There was no significant difference in tracheotomy-related complications between the two groups. Significantly decreased ventilator time was observed in the PDT during ECMO group. Conclusions: Despite poor coagulation of the day, PDT during ECMO is safe and can appropriately reduce the duration of mechanical ventilation compared with PDT after ECMO weaning in adult patients who have undergone cardiac surgery. [ABSTRACT FROM AUTHOR]

Copyright of Namık Kemal Tıp Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To compare procedure efficacy and postoperative complications of ultrasound-guided vs. bronchoscopy guided percutaneous dilatational tracheostomy, among obese ICU patients. Study type, settings & duration: The prospective, randomized & comparative study was conducted in critical care department of Services Hospital, Lahore from April 2020 to April 2021. Methodology: A total of 52 ICU patients were assigned into two groups (Group A-25 patients, and Group B-27 patients). Group A patients underwent ultrasound-guided percutaneous dilatational tracheostomy (PDT) and group B under conventional bronchoscopy guidance. In both groups, Ciaglia’s method of PDT was used among both groups. Patients were monitored for procedure time, number of punctures, peri and post-procedural complications: Bleeding, injury to nearby structures, hypoxemia, arrhythmias, difficulty to ventilate, pneumothorax, surgical emphysema, loss of airway, tracheal cartilage fracture and a new lung infiltrate, etc. Results: Intra-procedural complications were noted among four obese patients from both groups, i.e 1/15 (6.6%) in group A, and 3/14 (21.4%) in group B. The operation time was comparatively less in A as compared to group B. However, hospitalization duration in both the groups remained the same i.e 28 days. No postoperative complications were noted in either group. There were no conversions to surgical tracheostomy and deaths. Conclusion: Ultrasound-guided procedure is superior to bronchoscopy guided PDT among obese ICU patients with a low percentage of intra- and post-operative complications.

Patients with acute respiratory distress syndrome due to COVID-19 require intensive care unit (ICU) admission with consecutive endotracheal intubation and invasive mechanical ventilation. In patients with long-term mechanical ventilation, percutaneous dilatational tracheostomy (PDT) may be considered. This retrospective analysis includes clinical data on patients treated at the ICUs of the COVID Hospital of the Clinical Center of Vojvodina in the period from September 3, 2021 to May 1, 2022, and underwent PDT. Patients were predominantly male (n=48; 65.8%). Weaning from mechanical ventilation was achieved in 31 (42.5%) and decannulation in 25 (34.2%) patients. The mean time from polymerase chain reaction SARS CoV-2 positivity until PDT was 15.59±6.85 days. The mean time of endotracheal intubation before the PDT procedure was 7.37±4.89 days. The mean weaning time from mechanical ventilation was 10.45±7.92 days. Twenty-five (34.2%) patients were decannulated at the mean time of 19.60±11.81 days. The complications were tracheostomy related bleeding (2 patients), pneumothorax (4 patients), subcutaneous emphysema (1 patient) and cricoid cartilage injury (1 patient). PDT is a simple, safe, and effective procedure performed in COVID-19 patients in the ICU.

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Maintaining a patent airway is critical for treating patients with severe inhalation injuries. Percutaneous Dilatational Tracheostomy (PDT) has been used effectively for many patients treated in the Intensive Care Unit (ICU). In addition to its safety for use at the bedside, according to Friedman et al. PDT has the same or even lower complication rate than surgical tracheostomy. PDT can be performed in a shorter time and is more cost-effective. Herein, we report a 44 year old obese woman who sustained an inhalation injury related to a burn. The patient fell headfirst into a pot of boiling water at the time of the burn. The patient showed signs of inhalation injury and suffered a second-to-third degree burn injury. She was treated in the ICU, and early PDT was performed. The procedure was performed by first locating the trachea, followed by a 1-cm incision made between the second and third tracheal ring. She was intubated successfully and treated in the ICU for 7 days. The anesthesiologist chose to perform an early PDT to prevent further complications. This procedure was done successfully despite many comorbidities from the patient, such as being an obese female and having a short neck, which makes finding the exact location for the incision challenging. In this case, the early decision to proceed with PDT showed promising results in decreasing the patient's mortality risk. [ABSTRACT FROM AUTHOR]

Detailed reports are scarce on minimally-invasive tracheostomy (MIT) techniques for critically ill patients with challenging anatomy or complex coagulopathies. In such high-risk patients, conventional percutaneous dilatational tracheostomy (PDT) may lead to severe complications. Aiming to broaden the scope of MIT for patients previously excluded due to high risks, we developed a new care bundle (MIT technique), specifically designed for intensive care specialists. Our study examined the outcomes of MIT in 32 high-risk patients treated in an ICU of a University Hospital with specific focus on gastrointestinal and liver diseases. We have modified the conventional PDT technique by incorporating an initial skin incision, blunt dissection, diaphanoscopy-guided probe puncture, and continuous bronchoscopic monitoring. Our care bundle also introduces an anterolateral approach for tracheal entry, a significant advancement for patients with complex neck anatomy or dense vasculature, where an anterolateral trajectory avoids midline blood vessels. This enhanced method has proven to be safer than traditional PDT, with a notable absence of post-procedural hemorrhages, cannula misplacements, or infections. The use of our refined care bundle enabled swift minimally-invasive tracheostomy in high-risk patients without the occurrence of serious complications. [Display omitted] • Minimally invasive tracheostomy (MIT) in patients with pretracheal vasculature, atypical anatomy, or coagulation disorders. • MIT involves a skin incision, tissue dissection, a probe puncture guided by diaphanoscopy, and bronchoscopic surveillance. • The MIT approach is safe and can be performed without any complications. • MIT is faster and more efficient with regard to deployment of medical and nursing staff than surgical tracheostomy. [ABSTRACT FROM AUTHOR]

Abstract Objective Tracheostomies are performed in trauma patients for multiple purposes. Approaches to the procedure are usually directed by individual expertise and local preferences. Though generally safe, a tracheostomy can cause serious complications. This study aims to identify complications associated with tracheostomies performed at the level I Trauma Center of the Puerto Rico Medical Center (PRMC) to have an advanced foundation to develop and implement guidelines to improve patient outcomes. Study Design A retrospective cross‐sectional study. Setting Level I Trauma Center of the PRMC. Methods Medical charts of 113 trauma adult patients that underwent tracheostomy at the PRMC from 2018 to 2020 were reviewed. Data collected included patient demographics, surgical approach, initial tracheostomy tube size (ITTS), intubation period, and flexible laryngoscopic findings. Complications occurring during and after tracheostomy were documented. The unadjusted relationship of the independent variables and outcome measures was assessed using χ2 and Fisher's test for categorical variables and the Wilcoxon‐Mann‐Whitney rank‐sum test for continuous ones. Results Abnormal airway findings detected on flexible laryngoscopic examination were reported in 30 patients in the open tracheostomy (OT) group and 43 patients in the percutaneous tracheostomy group (p = 0.007). Peristomal granulation tissue was reported in 10 patients with an ITTS 8, while in only 1 patient with an ITTS 6 (p = 0.026). Conclusion This study showed several key findings in our cohort. The OT surgical approach was associated with fewer long‐term complications when compared to the percutaneous approach. Also, a statistically significant difference in peristomal granulation tissue findings was found between the ITTS, ITTS‐6 and ITTS‐8, the smaller size being associated with fewer abnormal findings.

Objective: To compare procedure efficacy and postoperative complications of ultrasound-guided vs. bronchoscopy guided percutaneous dilatational tracheostomy, among obese ICU patients. Study type, settings & duration: The prospective, randomized & comparative study was conducted in Critical Care Department of Services Hospital, Lahore from April 2020 to April 2021. Methodology: A total of 52 ICU patients were assigned into two groups (Group A-25 patients, and Group B-27 patients). Group A patients underwent ultrasound-guided percutaneous dilatational tracheostomy (PDT) and group B under conventional bronchoscopy guidance. In both groups, Ciaglia's method of PDT was used among both groups. Patients were monitored for procedure time, number of punctures, peri and post-procedural complications: Bleeding, injury to nearby structures, hypoxemia, arrhythmias, difficulty to ventilate, pneumothorax, surgical emphysema, loss of airway, tracheal cartilage fracture and a new lung infiltrate, etc. Results: Intra-procedural complications were noted among four obese patients from both groups, i.e 1/15 (6.6%) in group A, and 3/14 (21.4%) in group B. The operation time was comparatively less in A as compared to group B. However, hospitalization duration in both the groups remained the same i.e 28 days. No postoperative complications were noted in either group. There were no conversions to surgical tracheostomy and deaths. Conclusion: Ultrasound-guided procedure is superior to bronchoscopy guided PDT among obese ICU patients with a low percentage of intra- and post-operative complications. [ABSTRACT FROM AUTHOR]

Objectives: Percutaneous dilatational tracheostomy (PDT) is an interventional procedure that is widely used in intensive care units (ICUs). This application, which has low complication rates, increases patient comfort and facilitates airway management. However, early and late complications can be seen during and after the procedure. The objective of this study was to perform the clinical evaluation of PDT interventions applied in the ICU over a 10-year period. Methods: A total of 275 patients over the age of 18 who were hospitalized in the Surgical ICU and Anesthesia ICU and underwent PDT between 2010 and 2020 were included in the study. Patients’ age, gender, diagnosis of hospitalization, comorbid diseases, APACHE-II and Glasgow Coma Scale (GCS) scores, hospitalization and discharge dates, time to open tracheostomy, early and late complications encountered during and after the procedure, decannulation, transplantation, and mortality were retrospectively reviewed. Results: The mean age of the patients was 71.6±14.6 years. During ICU admission, APACHE II scores were 23.3±7.6 and GCS scores were 7.5±3.5. The highest mortality (22%) was in the ischemic or hemorrhagic cerebral injury group. The duration of mechanical ventilation in the ICU was 34.2±19.4 days, and the length of stay in the ICU was 37.2±20.5 days. Time to open a tracheostomy was found as 16.3±7.7 days. PDT was performed in the early (≤10 days) period in 33% of the patients, and in the late (>10 days) period in 67% of the patients. Twenty-seven (9.8%) of the 275 patients develop complications with bleeding being the most commonly seen complication by 4.4%. Conclusion: PDT is a safe procedure due to its low complication rates. However, we think that fiber optic bronchoscopy and ultrasonography, which are frequently used in different applications in ICUs, may also be effective in reducing complications in PDT applications. [ABSTRACT FROM AUTHOR]

Background: Percutaneous dilatational tracheostomy (PDT) is a common surgical procedure in the ICU. The present study was conducted to compare semi-surgical percutaneous dilatational tracheostomy (SSPDT) with conventional percutaneous dilatational tracheostomy (CPDT). Methods: The present randomized clinical trial was conducted on 160 patients hospitalized in the medical intensive care units (ICUs) with an indication for tracheostomy and were systematically divided into two equal groups of 80. In the CPDT group, after a small incision, a 16-gauge needle was blindly inserted into the trachea and the guidewire was placed inside the lumen. A stoma was created by passing a single dilator over the guidewire. In the SSPDT group, a transverse incision (2 cm) was made 1 cm below the cricoid, and the tracheal ring was then fully reached by releasing the subcutaneous tissues using the index figure, and PDT was then performed. The two groups were compared in terms of their tracheostomy complications (including bleeding, pneumothorax, stoma infection and accidental decannulation) and duration of the procedure. Results: The two groups were homogeneous in terms of age, gender, mean APACHE score (P>0.05). There were no significant differences between the two groups in terms of the mean time from tracheal intubation to tracheostomy (P=0.869). The duration of the procedure was 5.16±1.72 minutes in the SSPDT group and 6.42±1.71 in the CPDT group (P

Background and Aims: To overcome the procedure‑related complications associated with landmark‑guided percutaneous dilatational tracheostomy (PDT) ultrasound is emerging as a promising tool. Present study was designed to compare landmark‑guided PDT and ultrasound‑guided PDT in terms of efficiency, efficacy, and accuracy. Material and Methods: Hundred intensive care unit patients requiring prolonged mechanical ventilation were prospectively randomized into 2 groups of 50 patients each. In land mark guided (LMG) group, patients underwent landmark‑guided PDT, whereas in ultrasound guided (USG) group, patients underwent ultrasound‑guided PDT. Results: Both the groups were comparable in terms of demographic data, sequential organ failure assessment score, ventilator settings, and mean days on mechanical ventilation prior to PDT. The mean assessment time in the ultrasound‑guided group (1.56 ± 1 min) was significantly more (P‑value = 0.000) than in the landmark‑guided group (0.84 ± 0.72 min). The mean total procedure time for the USG group (5.98 ± 10.23 min) was more than that for the LMG group (4.86 ± 8.03 min) (P‑value 0.542). Deviation of puncture site from the midline was seen in two patients in group A as compared to none in the USG group (P‑value = 0.153). The number of patients requiring more than one attempt for successful needle insertion was more (P‑value = 0.148) in the LMG group (20%) as compared to USG group (8%). Incidence of complications, like bleeding and desaturation was more in the LMG group as compared to the USG group. Conclusion: Ultrasound‑guided PDT is associated with reduction in periprocedural complications as compared to landmark technique, although it takes slightly longer time. [ABSTRACT FROM AUTHOR]

Abstract Background Percutaneous dilatational tracheostomy (PDT) has become a widely performed technique in neurocritical care, which is however known to be accompanied by some risks to the patient. The aim of this pilot study was to assess the derecruitment effects of PDT with the electric impedance tomography (EIT) during the PDT procedure in neurocritical care. Methods The prospective observational pilot study investigated 11 adult, intubated, mechanically ventilated patients with acute brain disease. We recorded EIT data to determine regional ventilation delay standard deviation (RVD SD), compliance win (CW) and loss (CL), end-expiratory lung impedance (EELI), with the EIT belt placed at the level of Th 4 before, during and after the PDT, performed in the standard PDT position ensuring hyperextension of the neck. Results From 11 patients, we finally analyzed EIT data in 6 patients - EIT data of 5 patients have been excluded due to the insufficient EIT recordings. The mean RVD SD post-PDT decreased to 7.00 ± 1.29% from 7.33 ± 1.89%. The mean post-PDT CW was 27.33 ± 15.81 and PDT CL 6.33 ± 6.55. Only in one patient, where the trachea was open for 170 s, was a massive dorsal collapse (∆EELI − 25%) detected. In other patients, the trachea was open from 15 to 50 s. Conclusions This pilot study demonstrated the feasibility of EIT to detect early lung derecruitment occurring due to the PDT procedure. The ability to detect regional changes in ventilation could be helpful in predicting further progression of ventilation impairment and subsequent hypoxemia, to consider optimal ventilation regimes or time-schedule and type of recruitment maneuvres required after the PDT.

Abstract Background We evaluated severe pain-related adverse events (SAE) during the percutaneous dilatational tracheostomy (PDT) procedure performed by a neurointensivist and compared the outcomes with that of conventional surgical tracheostomy in neurocritically ill patients. Methods This was a retrospective and observational study of adult patients who were admitted to the neurosurgical intensive care unit between January 2014 and March 2018 and underwent tracheostomy. In this study, primary endpoints were incidence of SAE: cardiac arrest, arrhythmias, hypertension, hypotension, desaturation, bradypnea, or ventilatory distress. The secondary endpoint was procedure-induced complications. Results A total of 156 patients underwent tracheostomy during the study. Elective surgery of brain tumors (34.0%) and intracranial hemorrhage (20.5%) were the most common reasons for admission. The most common reasons for tracheostomy were difficult ventilator weaning or prolonged intubation (42.9%) and sedative reduction (23.7%). Tachycardia (30.1%) and hypertension (30.1%) were the most common SAE. Incidence of SAE was more common in conventional tracheostomy compared to PDT (67.1% vs. 42.3%, P = 0.002). The total duration of SAE (19.8 ± 23.0 min vs. 3.4 ± 5.3 min, P

Objective: In the current study, our primary aim is to compare complication rates between using ProSeal laryngeal mask airway (P-LMA) and endotracheal tube (ETT) in bronchoscopy-guided percutaneous dilatational tracheostomy (PDT) procedure. Our secondary aim is to compare the processing time of these two techniques. Methods: Sixty-one adult patients who were intubated in the intensive care unit and scheduled for PDT due to the need for long-term mechanical ventilation were included in the study. The patients were randomly divided into ETT group or P-LMA group under bronchoscopy guidance. Complications related to the procedures and the duration of each procedure were recorded. Hemodynamic measurements, oxygen saturation, arterial blood gas analysis, preferred mechanical ventilation mode, positive end expiratory pressure and mean airway pressure values were recorded before PDT, and 30 minutes after the procedure. Results: A total of 61 cases, 23 (38%) female and 38 (62%) male, participated in the study. Regarding the complication rates between the groups, we encountered more complications in the ETT group and the most common complication was puncture of the cuff of the intubation tube. The procedure time was also significantly shorter in the P-LMA group (P-LMA; 2.5 min, ETT; 3.6 min). Conclusion: Using P-LMA for PDT under bronchoscopy caused lower complication rate than using ETT. In a addition the duration of PDT procedure was shorter in P-LMA group than ETT group. [ABSTRACT FROM AUTHOR]

Background and Aims: Percutaneous dilatational tracheostomy (PDT) may improve the outcome in critically ill COVID-19 patients on mechanical ventilation. However, the timing of performing tracheostomy may be controversial, and it is an aerosol-generating procedure with a potential risk of viral exposure to healthcare workers. Material and Methods: An operational protocol for performing PDT was made and subsequently followed in a designated COVID-19 ICU. Critically ill adult patients on mechanical ventilators who underwent PDT were included in this retrospective cohort study. Case files were retrospectively reviewed and patient characteristics, clinical outcome, and procedure-related details were noted. Results: Forty-one patients were included in the analysis. The median age was 49 (39-67) years, and 41.5% of patients were females. The median duration of mechanical ventilation before tracheostomy was 10 (8-16) days, and the median (IQR) PaO2/FiO2 ratio on the day of PDT was 155 (125-180) mm Hg. Further, 48.8% of patients had transient desaturation to SpO2 <90%, and 41.5% survived to ICU discharge. None of the health care providers involved in PDT developed any symptoms of COVID 19. Conclusion: This descriptive study demonstrates the feasibility, implementation, and apparent safety of the PDT protocol developed at our institution. [ABSTRACT FROM AUTHOR]

Background: Percutaneous dilatational tracheostomy (PCDT) using fiber-optic bronchoscope (FOB) is a widely practiced technique, but its availability and cost remain a concern in nations with limited resources. Mini-surgical technique of PCDT incorporating minimal blunt dissection has shown improved results even without the use of FOB. The study is primarily intended to compare these two techniques and establish a safer cost-effective alternative to FOB-guided PCDTs. Patients and methods: This randomized comparative study [registered (CTRI/2018/04/013191)] was conducted on 120 mechanically ventilated patients. In 60 patients, mini-surgical PCDT (group-M) was performed with 2 cm longitudinal skin incision and blunt dissection till pretracheal fascia without FOB guidance using Portex-Ultraperc™ sets. In remaining 60 patients, PCDT was performed under FOB vision with similar skin incision (without blunt dissection) using Portex-Ultraperc™ sets (group-F). Two techniques were compared with regard to procedural time and percentage of complications occurred during or after the procedure. Results: Procedure time [group-M: 6.30 ± 1.28 minutes; group-F: 14.43 ± 1.84 minutes (p <0.001)] and mean blood loss [group-M: 5.33 ± 1.69 mL; group-F: 6.87 ± 3.11 mL (p = 0.001)] was significantly less in group-M. Higher incidence of desaturation [group-M: 16.7%; group-F: 35% (p = 0.022)] was noted in group-F, whereas arrhythmias [group-M: 21.7%; group-F: 6.7% (p = 0.018)] were higher in group-M. There was no statistical difference in incidence of pneumothorax and subcutaneous emphysema. There was no incidence of posterior tracheal wall perforation in any of the patients. Conclusion: Mini-surgical technique is a faster alternative of FOB-guided PCDT with comparable incidence of complications. It can safely be used in intensive care units (ICUs) where FOB is not available. [ABSTRACT FROM AUTHOR]

Background: Percutaneous dilatational tracheostomy (PDT) is a common surgical procedure in the ICU. The present study was conducted to compare semi-surgical percutaneous dilatational tracheostomy (SSPDT) with conventional percutaneous dilatational tracheostomy (CPDT). Methods: The present randomized clinical trial was conducted on 160 patients hospitalized in the medical intensive care units (ICUs) with an indication for tracheostomy and were systematically divided into two equal groups of 80. In the CPDT group, after a small incision, a 16-gauge needle was blindly inserted into the trachea and the guidewire was placed inside the lumen. A stoma was created by passing a single dilator over the guidewire. In the SSPDT group, a transverse incision (2 cm) was made 1 cm below the cricoid, and the tracheal ring was then fully reached by releasing the subcutaneous tissues using the index figure, and PDT was then performed. The two groups were compared in terms of their tracheostomy complications (including bleeding, pneumothorax, stoma infection and accidental decannulation) and duration of the procedure. Results: The two groups were homogeneous in terms of age, gender, mean APACHE score (P>0.05). There were no significant differences between the two groups in terms of the mean time from tracheal intubation to tracheostomy (P=0.869). The duration of the procedure was 5.16±1.72 minutes in the SSPDT group and 6.42±1.71 in the CPDT group (P<0.001). The complication rate was 7(8.75%) in the SSPDT group and 16(20%) in the CPDT group (P=0.043). Conclusion: SSPDT is safer and has fewer complications than CPDT in ICU patients. [ABSTRACT FROM AUTHOR]

Background: Percutaneous dilatation tracheostomy (PDT) is required in patients with novel coronavirus disease-2019 (COVID-19) with severe respiratory involvement, but the procedure needs modification to minimize the risk of aerosol exposure to caregivers. Aim and objective: To share the experience of apnea approach of PDT in COVID patients. Also, to demonstrate the safety of the technique for healthcare workers (HCWs) and patients with respect to hemodynamic and oxygenation parameters. The incidence of adverse events and difficulties during the procedure were also recorded. Materials and methods: According to this modified approach, percutaneous tracheostomy was performed with apnea technique during open tracheal steps (video attached) and the endotracheal tube was withdrawn to the level of cords under video-laryngoscopic guidance. Study design: A retrospective data analysis of all the tracheostomy procedures (PDT) performed with the apnea technique during the COVID era (June--September) in non-COVID and COVID patients in intensive care units (ICUs). Results: During these 4 months, 74 PDT procedures were performed in both COVID and non-COVID patients in the ICUs of our hospital. Out of these, PDT with apnea technique was performed in 45 patients (61%). This technique was successful in 44 patients (97.7%) with mean apnea time of 110 + 8.6 seconds. There was no significant (p < 0.05) change in mean arterial pressure and oxygen saturation of 15 COVID patients in pre-PDT and immediate post-PDT period. None of the six team members performing PDT had symptoms or tested positive for COVID-19. Conclusion: PDT with apnea technique can be performed to minimize the risk of aerosol exposure and does not compromise the quality of care. It is safe both for the patient and HCWs. [ABSTRACT FROM AUTHOR]

Percutaneous dilatational tracheostomy (PDT) is a routinely performed procedure in the intensive care unit (ICU). Bronchoscopy guidance is recommended which requires expertise to use it, and also it is not readily available in all ICUs. Moreover, it can lead to carbondioxide (CO2) retention and hypoxia during the procedure. To overcome these issues, we are using a waterproof 4 mm borescope examination camera in place of a bronchoscope which allows continuous ventilation, and real-time images of the tracheal lumen can be viewed on a smartphone or a tablet during the procedure. These real-time images can be transmitted wirelessly to a control room where experts can monitor and guide the junior staff performing the procedure. We are reporting successful use of the borescope camera during PDT. [ABSTRACT FROM AUTHOR]

Aim An early tracheostomy is often considered for patients with veno‐venous extracorporeal membrane oxygenation (VV‐ECMO). However, there is no consensus on the timing of a tracheostomy in patients on VV‐ECMO for coronavirus disease 2019 (COVID‐19). The present report described the optimal timing of tracheostomy for these patients. Method The present study was a single‐center case series. We retrospectively reviewed the medical records of nine consecutive patients who underwent tracheostomy either during or after VV‐ECMO treatment in our center between January 1, 2020 and December 31, 2020. Results All the patients received a percutaneous dilatational tracheostomy, which was performed during VV‐ECMO in four patients. Three of these patients experienced hemorrhagic complications, and the remaining patient required a circuit change on the day after the operation. Heparin was discontinued 8 h preoperatively and resumed 1–14 h later. The platelet count was below normal in two patients, but no transfusion was performed. APTT was almost normal, and D‐dimer was elevated postoperatively. The remaining five patients received a tracheostomy after weaning off VV‐ECMO, and no complication was observed. Eight patients were deeply sedated during VV‐ECMO to prioritize lung rest and prevent infecting the healthcare workers. Conclusion In the present study, patients who underwent a tracheostomy during VV‐ECMO tended to have more hemorrhagic complications. Because an early tracheostomy during ECMO has little benefit for patients with COVID‐19, it should be performed after weaning off VV‐ECMO to protect the safety of the healthcare workers concerned.

Background and purpose: Percutaneous dilatational tracheostomy is widely accepted in many Intensive Care Units (ICU) in the word. The aim of this study was to compare the complications of Modified Percutaneous Dilatational Tracheostomy (MPDT) with or without bronchoscopy. Materials and methods: A randomized clinical trial was performed in 270 ICU patients, candidate for tracheostomy in Babol Rouhani Hospital, between April 2013 and May 2018. They were systematically divided into two groups. MPDT was carried out in both groups. At first, the transverse section (2 cm) was given 1 cm below the cricoid cartilage, then PDT was performed after seeing the trachea ring. In the first group, PDT was performed without a bronchoscope and in the second group the PDT was done applying bronchoscopic guide. The procedure time, waiting time to tracheostomy, complications such as hemorrhage, stomal infection, and pneumothorax were compared in two groups. Data were analyzed in SPSS V22 using Chi-square, independent sample, and Fisher exact test. Results: There were no differences between the two groups in age, sex, mean apache score, and mortality (P> 0.05). The mean waiting time to tracheostomy was not significantly different (P= 0.632). The procedure time in the PDT without bronchoscopy was 6.44 ± 3.54 min and in the PDT with bronchoscopy was 9.25 ± 3.30 min (P

Background Although percutaneous dilatational tracheostomy (PDT) under bronchoscopic guidance is feasible in the intensive care unit (ICU), it requires extensive equipment and specialists. The present study evaluated the feasibility of performing PDT with a light source in the surgical ICU. Methods The study involved a retrospective review of the outcomes of patients who underwent PDT with a light source performed by a surgery resident under the supervision of a surgical intensivist in the surgical ICU from October 2015 through September 2016. During the procedure, a light wand was inserted into the endotracheal tube after skin incision. Then, the light wand and the endotracheal tube were pulled out slightly, the passage of light through the airway was confirmed, and the relevant point was punctured. Results Fifty patients underwent PDT with a light source. The average procedural duration was 14.0 ± 7.0 minutes. There were no procedure-associated deaths. Intraoperative complications included minor bleeding in three patients (6%) and paratracheal placement of the tracheostomy tube in one patient (2%); these were immediately resolved by the surgical intensivist. Two patients required conversion to surgical tracheostomy because of the difficulty in light wand insertion into the endotracheal tube and a very narrow trachea, respectively. Conclusions PDT with a light source can be performed without bronchoscopy and does not require expensive equipment and specialist intervention in the surgical ICU. It can be safely performed by a surgical intensivist with experience in surgical tracheostomy.

Background & Objective: COVID 19 patients with severe respiratory failure may require prolonged mechanical ventilation. Placement of a tracheostomy tube often becomes necessary for such patients. The steps of tracheostomy procedure and post tracheostomy care of these patients can be classified as aerosol generating. We wish to highlight our modified technique to address these issues. Methods: We performed percutaneous dilation tracheostomy in three clinically challenging COVID-19 patients in our ICU and developed guidelines aiming to minimise aerosolisation during and after the tracheostomy procedure to safeguard healthcare workers. Results: Percutaneous tracheostomy was performed by a team of three experienced anaesthetists and an ICU nurse. Conclusion: The decision of surgical or percutaneous tracheostomy should be dependent on the experience of the tracheostomy performer, health-care worker safety, resource availability, and patient-centred care. We believe our modified strategic approach of brief bronchoscopy, minimum PEEP and gas flows and stepwise planned approach for PCDT offers an extra level of safety to healthcare workers. [ABSTRACT FROM AUTHOR]

Background: The role of tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic remains unknown. The goal of this consensus statement is to examine the current evidence for performing tracheostomy in patients with respiratory failure from COVID-19 and offer guidance to physicians on the preparation, timing, and technique while minimizing the risk of infection to health care workers (HCWs).Methods: A panel including intensivists and interventional pulmonologists from three professional societies representing 13 institutions with experience in managing patients with COVID-19 across a spectrum of health-care environments developed key clinical questions addressing specific topics on tracheostomy in COVID-19. A systematic review of the literature and an established modified Delphi consensus methodology were applied to provide a reliable evidence-based consensus statement and expert panel report.Results: Eight key questions, corresponding to 14 decision points, were rated by the panel. The results were aggregated, resulting in eight main recommendations and five additional remarks intended to guide health-care providers in the decision-making process pertinent to tracheostomy in patients with COVID-19-related respiratory failure.Conclusion: This panel suggests performing tracheostomy in patients expected to require prolonged mechanical ventilation. A specific timing of tracheostomy cannot be recommended. There is no evidence for routine repeat reverse transcription polymerase chain reaction testing in patients with confirmed COVID-19 evaluated for tracheostomy. To reduce the risk of infection in HCWs, we recommend performing the procedure using techniques that minimize aerosolization while wearing enhanced personal protective equipment. The recommendations presented in this statement may change as more experience is gained during this pandemic. [ABSTRACT FROM AUTHOR]

Tracheostomy in COVID-19-related severe acute respiratory syndrome is at high risk of viral dissemination. The percutaneous dilatation technique could reduce this risk, being performed at the bedside and minimising airway opening. In the COVID-19 context, however, with precarious respiratory status, it requires specific preparation. We designed a 3-hour training module, and here provide a step-by-step schedule, including video analysis, a demonstration of the kit, the recommended precautions related to COVID-19, and several simulation scenarios of increasing difficulty, using a high-tech mannequin. A low-tech procedural simulator was also developed for practicing the steps of the procedure. Our experience (3 sessions with 14 participants) highlighted the difficult points of the procedure in the COVID-19 context, and defined a checklist for clinical practice and an assessment grid. This type of simulation helps to prepare teams for a potentially delicate technical act. [ABSTRACT FROM AUTHOR]

Objective: Percutaneous dilatational tracheostomy (PDT) is a routine procedure in the intensive care unit. PDT can be performed under the guidance of fiberoptic bronchoscopy (FOB), that it increases safety and causes less complications and tissue damage. The aim of this study was to determine whether the FOB-guided PDT decreases the complication rate and improves safety. Method: PDT cases performed with or without the guidance of FOB by Griggs method between January 2017 and January 2018 were evaluated retrospectively. Information about the age, gender, hospitalization in the intensive care unit and PDT indications, the time (days) until the opening of the tracheostomy and total procedure time, mortality were obtained from patients’ files. Complications observed in the first 24 hours of later were evaluated as early and late complications. Minor bleeding (< 10 mL), hypotension, arrhythmia, hypercapnia, hypoxia were considered as minor complications. Major hemorrhage, pneumothorax, hemothorax, false passage, subcutaneous emphysema were defined as major complications. Results: A total of 103 patients were included in the study. PDT procedure was performed with (n=44: 42.7%) and without (n=59: 57.3%) the guidance of FOB. During the procedure, SaO₂ values were found as 75% (40%,100%) and 98% (93%, 100%) in PDT procedures performed with and without the aid of FOB, respectively. The mean total duration PDT procedure performed with and without the guidance of FOB was 25.2±6 min, and 20±6 min, respectively. Fourteen patients (31.8%) developed early complications and 6 patients (13%) major complications in non-FOB group. The rate of early complications in the FOB-PDT group was 13.5% (8 patients). One patient (1.7%) developed major bleeding requiring surgical intervention. Tracheoesophageal fistula was observed in one patient (1.7%) 270 days after tracheostomy in the FOB-PDT group. Conclusion: We think that it is safer to perform PDT with the aid of FOB. Although the duration of FOB-guided PDT procedure was longer, we found that the complications of the procedure were reduced. [ABSTRACT FROM AUTHOR]

Background: Percutaneous dilatational tracheostomy have been performed increasingly since its introduction in 1985, and is today one of the most commonly performed operative procedures in intensive care units. The aim of this study was to document patient-reported outcomes from percutaneous dilatational tracheostomy after hospital discharge.Methods: This study is based on retrospective extraction of data from the databases in the ICU at Haukeland University Hospital from 2004 to 2016. Patients alive by April 2018 and with a code for dilatation tracheostomy were sent a questionnaire about their experiences with having a tracheostomy performed. The occurrence of problems and their relations were registered.Results: Of 5769 admitted patients, 900 patients ≥ 15 years (15.7%) had a percutaneous dilatation tracheostomy performed. The median time from admission to follow-up was 6.1 years, and the 30 days mortality in those who received a tracheostomy was 315/900 (35%). Of the 441 survivors contacted, 181 answered the questionnaire and a total of 293 problems were reported. The majority of these problems were reported as no or moderate in 115 patients (78.3%). The presence of any problem was significantly associated with occurrence for other problems; however, there were no significant differences related to the elapsed time since the ICU stay. Pain and difficulties with breathing were the two single factors most often related to occurrence of other problems.Conclusion: Although self-reported problems after percutaneous tracheostomy occurring after hospital discharge were often reported, most (78.3%) were considered by the patients to be moderate. [ABSTRACT FROM AUTHOR]

Background: We evaluated severe pain-related adverse events (SAE) during the percutaneous dilatational tracheostomy (PDT) procedure performed by a neurointensivist and compared the outcomes with that of conventional surgical tracheostomy in neurocritically ill patients.Methods: This was a retrospective and observational study of adult patients who were admitted to the neurosurgical intensive care unit between January 2014 and March 2018 and underwent tracheostomy. In this study, primary endpoints were incidence of SAE: cardiac arrest, arrhythmias, hypertension, hypotension, desaturation, bradypnea, or ventilatory distress. The secondary endpoint was procedure-induced complications.Results: A total of 156 patients underwent tracheostomy during the study. Elective surgery of brain tumors (34.0%) and intracranial hemorrhage (20.5%) were the most common reasons for admission. The most common reasons for tracheostomy were difficult ventilator weaning or prolonged intubation (42.9%) and sedative reduction (23.7%). Tachycardia (30.1%) and hypertension (30.1%) were the most common SAE. Incidence of SAE was more common in conventional tracheostomy compared to PDT (67.1% vs. 42.3%, P = 0.002). The total duration of SAE (19.8 ± 23.0 min vs. 3.4 ± 5.3 min, P < 0.001) and procedural time (42.2 ± 21.8 min vs. 17.7 ± 9.2 min, P < 0.001) were longer in conventional tracheostomy compared to PDT. Multivariable adjustment revealed that only PDT by a neurointensivist significantly reduced the incidence of SAE by one third (adjusted odds ratio [OR]: 0.36, 95% confidence interval [CI]: 0.187-0.691). In addition, PDT by a neurointensivist deceased the duration of SAE by 8.64 min (β: -8.64, 95% CI: - 15.070 - -2.205, P = 0.009) and prolonging the procedure time by every one minute significantly increased the duration of SAE by 6.38 min (β: 6.38, 95% CI: 0.166-0.470, P < 0.001). Procedure-induced complications were more common in conventional tracheostomy compared to PDT (23.5% vs. 11.3%, P = 0.047).Conclusions: This retrospective and exploratory study of our single-center limited cohort of tracheostomy patients revealed that decreased SAE may be associated with short procedural time during the PDT procedure performed by a neurointensivist. It is proposed that PDT by a neurointensivist may be safe and feasible in neurocritically ill patients. [ABSTRACT FROM AUTHOR]

Aim: To compare the applicability, technical difficulties and postoperative complications of surgical tracheostomy and percutaneous dilatational tracheostomy with the flexible lightwand + ultrasonography method applied because of prolonged intubation to geriatric patients in the intensive care unit. Methods: A retrospective evaluation was made of 76 patients who received surgical tracheostomy (group 1) and 78 patients who received percutaneous dilatational tracheostomy (group 2). The patients were evaluated in respect of demographic data, duration of intubation, length of stay in the intensive care unit and discharge status, and after the intervention, the development of tube‐related complications, early stage local complications and late‐stage complications. Results: The time from intubation to tracheostomy was determined as 22.73 ± 15.23 days in group 1 and 12.65 ± 7.64 days in group 2. The mortality rate of patients in group 1 was determined to be statistically significantly higher than that of group 2 (P = 0.048). When evaluated in respect to early and late complications, nine early‐ and seven late‐stage complications developed in group 1, and three early‐ and three late‐stage complications developed in group 2 (P = 0.05). In the evaluation of factors related to mortality, the time from intubation to tracheostomy (r = 0.249, P = 0.01) and the presence of a comorbidity (r = 0.325, P = 0.004) were determined to have a positive correlation with the development of mortality. Conclusion: Percutaneous dilatational tracheostomy with the flexible lightwand + ultrasonography technique is a safe, rapid and effective method with the advantage of management in respect to early complications, such as bleeding, and can be used safely in the geriatric patient population in intensive care conditions. Geriatr Gerontol Int 2020; ••: ••–••. [ABSTRACT FROM AUTHOR]