Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy in Critically Ill Patients: A Study of Complication and Expanded Utility

Background: Bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT) is one of the most frequently performed procedures in critically ill patients. Complications occur in 5% to 40% of tracheostomies depending on study design, patient follow-up, and the definition of the different complications. The mortality rate of PCT is less than 2%. We conducted this study to assess the complications and expanded utility of BG-PDT in the Indian setting.

Materials and Methods: A retrospective analysis of 116 BG-PDT performed in the past 3 years was done. PDT was done using the standard technique, using the Cook PDT kit and videobronchoscopy guidance, with all steps done under vision. Postprocedure, all clots which migrated to the distal airway were suctioned. Complications were noted. Additional BAL was done in patients with infiltrates for cultures.

Results: One hundred sixteen BG-PDT were performed. The most common indication for BG-PDT was anticipated prolonged ventilator stay to facilitate weaning. Complications were divided into intra-procedural and early postprocedural complications. Positive BAL culture was also analyzed.

Conclusions: Our study shows that BG-PDT is safe with minimal complications, when performed by experienced ICU personnel. The advantages include confirming all steps under vision, postprocedure suctioning of clots, and BAL done in the same setting. We propose BG-PDT as an “expanded PDT strategy,” combining a safe visually guiding procedure with clot clearance, and additional BAL for cultures.

Publication History

Article published online:
25 March 2020