Fibre-Optic Bronchoscopy-Assisted Percutaneous Dilatational Tracheostomy by Guidewire Dilating Forceps in Intensive Care Unit Patients

Abstract

Objective: The purpose of this study was to prospectively analyze intensive care unit patients with fibre-optic bronchoscopy assisted percutaneous dilatational tracheostomy by guidewire dilating forceps (GWDF; Griggs percutaneous tracheostomy). Design: Prospective study. Setting: A tertiary care centre. Materials and Methods: Fifty-two critically ill patients (32 men and 20 women), aged 16 to 84 years (mean +/- 6 SD 42 +/- 1.6 years) who required endotracheal intubation for longer than 15 days were consecutively selected to undergo tracheostomy by the GWDF technique. The diagnoses of the patients and intraoperative and postoperative complications were recorded. Results: The patients were mechanically ventilated for an average of 14.8 +/- 1.2 days. The duration of the GWDF technique was 4.9 +/- 1.7/min. Intraoperative complications occurred in 10 (19.2%) patients: hemorrhage in 3 cases, puncture of the tracheal tube in 2 cases, difficult cannulation in 2 cases, difficult dilatation in 1 case, false passage in 1 case, and inadvertent extubation in 1 case. Postoperative complications occurred in three (5.7%) patients, stomal cellulitis in one case, subcutaneous emphysema in one case, and difficult recannulation in the remaining case. Conclusions: Fibre-optic bronchoscopy-assisted percutaneous dilatational tracheostomy by GWDF is a simple and fast technique for inserting a tracheal cannula.