Percutaneous Tracheostomy Boundaries Revisited

Abstract

Objectives: As percutaneous tracheostomies (PCT) which have various contra-indications (CI) are increasingly performed by non-otolaryngologists, the otolaryngologist’s role is reviewed. The ability of tracheal palpation was the single criteria to perform PCT. Methods: A retrospective study analyzing adult PCT performed by otolaryngologists from 2011-2012. All PCT were performed using the Ciaglia blue-rhino-tracheostomy kit and Shiley’s tracheostomy cannulas. Most procedures were performed with the same anesthesiologist. Results: A total of 60 PCT were identified with subject ages 18-91. None were converted to open tracheostomy. No bronchoscopic guidance was used. PCT was performed for the following CI: 2 bleeding disorder, 4 goiters, 4 cervical rigidity (surgical, traumatic and constitutional), 5 emergent tracheostomies, 1 head and neck cancer 9 short necks. Complications recorded were 1 wound bleeding and 1 pneumomediastinum, both controlled locally. Pertinent anatomy revealed the intubation tube was withdrawn to the level of 14cm and 16cm from incisor level in women and men respectively. Conclusions: PCT is a safe procedure. When performed by an otolaryngologist even the relative CI can be overcome. Tracheal palpation and an experienced anesthesiologist are mandatory for the procedure’s success. The otolaryngologists’ advantage is a better anatomical understanding with the ability to convert the procedure to a formal tracheostomy as needed and avoidance of hypercarbia due to bronchoscope use. Otolaryngologists should be the first line providers in any tracheostomy