Classical Blind Percutaneous Dilatational Tracheostomy vs Fiberoptic Bronchoscopy Guided Percutaneous Dilatational Tracheostomy in the Intensive Care Unit: Complications, Mortality, and Outcomes

Abstract

Aim: This study aimed to compare percutaneous dilatational tracheostomy (PDT) procedures performed with fiberoptic bronchoscopy (FOB) guidance and classical blind technique regarding complications, mortality, and patient outcomes. Material and Methods: This study included 62 patients receiving mechanical ventilator support in the intensive care unit (ICU) between October 2022 and June 2023. Patients were randomized into two groups: those who underwent FOB-guided PDT (group FOB, n=31) and those who underwent PDT with the classical blind technique (group C, n=31). Demographic data, clinical characteristics, PDT procedure times, complications, and mortalities were analyzed. Results: The median age was 64 (range, 19-94) years, and 67.7% (n=42) of the patients were male. Demographic data were found similar between groups. The most common primary diagnosis in patients who underwent PDT was intracranial hemorrhages (32.3%, n=20). While the median tracheostomy opening time in the entire study group was 13 (range, 3-31) days, there was no significant difference between the groups (p=0.637). The mean PDT procedure time (9.6±3.8 vs 12.6±5.4 min, p=0.015), median ICU stay (26 vs 37 days, p=0.004), and complication rate (6.4% vs 25.8%, p=0.038) were found to be significantly lower in group FOB. While the 28-day mortality in the entire study group was 17.7% (n=11), there was no significant difference between the groups (p=0.740). Conclusion: In PDT procedures performed under FOB guidance, procedure time, length of stay in the ICU, and procedure-related complication rates were significantly lower, while no significant difference was observed in terms of mortality.

Keywords

• Tracheostomy
• Bronchoscopy
• Intensive care unit
• mechanical ventilation
• ventilator weaning

Yoğun Bakım Ünitesinde Fiberoptik Bronkoskopi Kılavuzluğunda Perkütan Dilatasyonel Trakeostomiye Karşı Klasik Kör Perkütan Dilatasyonel Trakeostomi: Komplikasyonlar, Mortalite ve Sonuçlar

Öz

Amaç: Bu çalışmanın amacı, fiberoptik bronkoskopi (FOB) kılavuzluğu ile klasik kör teknikle gerçekleştirilen perkütan dilatasyonel trakeostomi (PDT) işlemlerinin komplikasyonlar, mortalite ve hasta sonuçları açısından karşılaştırılmasıdır. Gereç ve Yöntemler: Bu çalışmaya Ekim 2022 ile Haziran 2023 tarihleri arasında yoğun bakım ünitesinde (YBÜ) mekanik ventilatör desteği alan 62 hasta dahil edildi. Hastalar FOB kılavuzluğunda PDT gerçekleştirilenler (grup FOB, n=31) ve klasik kör teknikle PDT gerçekleştirilenler (grup C, n=31) olarak iki gruba randomize edildi. Demografik veriler, klinik özellikler, PDT işlem süreleri, komplikasyonlar ve mortaliteler analiz edildi. Bulgular: Ortanca yaş 64 (aralık, 19-94) yıl ve hastaların %67,7’si (n=42) erkek idi. Gruplar arasında demografik verilerin benzer olduğu saptandı. PDT işlemi gerçekleştirilen hastalarda en sık primer tanı intrakranyal hemorajiler (%32,3; n=20) idi. Tüm çalışma grubunda medyan trakeostomi açılma zamanı 13 (aralık, 3-31) gün iken gruplar arasında anlamlı bir farklılık yoktu (p=0,637). Ortalama PDT işlem süresi (9,6±3,8’e karşı 12,6±5,4 dakika, p=0,015), ortanca YBÜ kalış süresi (26’ya karşı 37 gün, p=0,004) ve komplikasyon oranı (%6,4’e karşı %25,8; p=0,038) grup FOB’da anlamlı olarak daha düşük saptandı. Tüm çalışma grubunda 28 günlük mortalite %17,7 (n=11) iken gruplar arasında anlamlı bir farklılık yoktu (p=0,740). Sonuç: FOB kılavuzluğunda gerçekleştirilen PDT işlemlerinde, işlem süresi, YBÜ kalış süresi ve işleme bağlı görülen komplikasyon oranları anlamlı olarak düşük saptanırken, mortalite açısından anlamlı bir farklılık görülmedi.

Anahtar Kelimeler

• Trakeostomi
• Bronkoskopi
• Yoğun bakım ünitesi
• mekanik ventilasyon
• ventilatörden ayrılma

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