Percutaneous dilatational tracheostomy. A safe, cost-effective bedside procedure

R. Cobean, M. Beals, C. Moss and C. E. Bredenberg
Department of Surgery, Maine Medical Center, Portland, USA.

OBJECTIVE: To evaluate the safety and cost-effectiveness of percutaneous dilatational tracheostomy performed in the intensive care unit. DESIGN: Retrospective review of 65 patients with cost-effectiveness analysis. SETTING: University-affiliated tertiary care teaching hospital with a 34-bed combined medical-surgical intensive care unit. PATIENTS: All patients who underwent percutaneous dilatational tracheostomy under the supervision of a single general surgeon during a 19-month period. Cost analysis was based on comparison with standard operative tracheostomies performed during the same period. RESULTS: Percutaneous dilatational tracheostomy was completed in all patients in whom it was attempted, regardless of airway anatomy, body habitus, and ventilator settings. The mean duration of the procedure performed in the intensive care unit was 13.6 minutes (95% confidence interval, 11.7 to 15.5 minutes). Intraoperative complications occurred in 14 patients (22%), most of which were minor technical difficulties, and none resulted in serious morbidity. Postoperative complications occurred in six patients (9%), including one death secondary to premature decannulation, three bleeding complications, one episode of subcutaneous emphysema, and one air leak. Two long-term airway complications after percutaneous dilatational tracheostomy were documented during a mean 7.5-month follow-up of 28 patients. Mean patient charges for the procedure performed in the intensive care unit by a surgeon, nurse, and respiratory therapist were $997 (95% confidence interval, $975 to $1018) compared with $2642 (95% confidence interval, $2513 to $2772) for standard tracheostomy (P<.001). This represented a savings of $1645 (95% confidence interval, $1492 to $1798) per tracheostomy. CONCLUSIONS: Percutaneous dilatational tracheostomy is a safe, rapid, cost-effective alternative to standard open tracheostomy. It can be performed at the bedside, obviating the need to transport critically ill patients from their optimal intensive care unit environment.

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