Percutaneous Dilatational Tracheostomy: Experience of 100 Cases at a Tertiary Care Centre

Tracheostomy has been accepted as standard of care for patients requiring prolonged mechanical ventilation. There has been a shift from the era of open surgical tracheostomy to percutaneous tracheostomy. Some studies have reported certain advantages of percutaneous tracheostomy over open tracheostomy, yet some centres debate about its effectiveness and, hence, have not adopted it as a routine technique. We present our centre’s experience of performing 100 bedside percutaneous tracheostomies, including those in 27 patients of cervical spine injury. The aim of the study is to demonstrate the safety and efficacy of percutaneous tracheostomy such that it can be embraced as a routine technique. One hundred consecutive neurosurgical patients requiring tracheostomy for prolonged ventilation were included in the study. Patients requiring emergency tracheostomy were excluded. A prospective database was created which included demographic profile of the patient, diagnosis and related indications, procedure time and complications. Ciaglia multiple dilator technique was used for performing percutaneous tracheostomy using Cook set. Time taken was measured from skin incision to insertion of tracheostomy tube. All related complications were noted. Mean duration of procedure was 7.92 ± 0.17 min and 7.14 ± 0.1 min in patients of cervical spine injury. Cannula misplacement occurred in 5 patients and minor bleeding occurred in 4 patients, including 3 complications in patients of cervical spine injury(2 had bleeding while 1 had cannula misplacement corrected during the procedure). Conversion to open procedure was required in one patient. Percutaneous tracheostomy is a safe and effective alternative to open tracheostomy. It can be considered the first line of care in patients requiring tracheostomy, especially in patients of cervical spine injury.