clinical investigations in critical care

Study objective: The percutaneous dilatational tracheostomy can be performed with a low compli¬ cation rate if several important technical details are followed. This study delineates our experience and recommends changes in the operative technique. Design and setting: Patients requiring tracheostomy were selected for percutaneous dilatational tracheostomy based on previously reported criteria. The procedures were performed routinely in the ICU unless there was another reason to transport the patient to the operating room. The patients were monitored with an ECG and pulse oximetry. End-tidal CO2 and ventilator settings were noted by the respiratory therapist. The airway was controlled using the bronchoscope and manually by the respiratory therapist. Adjustments were made in respiratory rate or tidal volume as indicated by an increase in end-tidal CO2. Patients and measurements: We report our experience with 254 patients who underwent percuta¬ neous dilatational tracheostomy. We prospectively recorded intraoperative, early, and late compli¬ cations. From our personal experience of 170 cases previously reported and 84 recent cases, we find that there are several important technical details in performing the procedure that will minimize complications. Results: (1) Use of a deflated endotracheal tube cuff and increased tidal volume on the ventilator to compensate for lost minute volume and maintain normal PaCC>2; (2) an adequate skin incision to