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Original Investigation |

Use of Bronchoscopy in Percutaneous Dilational Tracheostomy

Shekhar K. Gadkaree, BS1; Diane Schwartz, MD2; Kevin Gerold, DO, JD3; Young Kim, MD, PhD1
[+] Author Affiliations
1Department of Otolaryngology–Head & Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
2Department of General Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
3Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
JAMA Otolaryngol Head Neck Surg. 2016;142(2):143-149. doi:10.1001/jamaoto.2015.3123.
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Importance  A modified percutaneous dilational tracheostomy (PDT) is a relatively new alternative method of performing PDTs in which tissues overlying the trachea are dissected, but needle entry is still performed blindly. Many centers use bronchoscopy-assisted PDT, but the necessity of bronchoscope assistance for modified PDTs has not been examined. Discontinuing bronchoscopy for this procedure could potentially decrease cost and increase efficiency with similar outcomes compared with bronchoscopy-assisted PDT.

Objective  To evaluate the necessity of bronchoscopy in placement of PDT.

Design, Setting, and Participants  A single-center, retrospective cohort study of 149 patients who underwent PDT, with or without bronchoscope assistance, was conducted between May 1, 2007, and February 1, 2015, in a tertiary care facility. Data analysis was performed from April 15, 2015, to May 1, 2015.

Interventions  Modified PDT with or without bronchoscopy.

Main Outcomes and Measures  The primary outcomes of interest were postprocedural complications and length of stay during the hospitalization at which the tracheostomy was placed.

Results  Of the 149 patients who underwent modified PDT during the study period and met the inclusion criteria, 107 were in the no-bronchoscope cohort (66 [61.7%] were men; mean [SD] age, 56.0 [18.7] years) and 42 were in the bronchoscope-assisted cohort (26 [61.9%] were men; mean [SD] age, 58.0 [15.7] years). Complications with PDT were significantly associated with use of a bronchoscope (odds ratio, 6.7; 95% CI, 1.3-43.4; P = .04). The rate of complications was 1.9% in the no-bronchoscope cohort and 11.9% in the bronchoscope-assisted cohort (P = .05). The mean (SD) length of hospital stay was not significantly different between the 2 groups (51.4 [49.4] days in the no-bronchoscope cohort vs 46.9 [28.6] days in the bronchoscope-assisted cohort; P = .58).

Conclusions and Relevance  Percutaneous dilational tracheostomy can be performed with similarly low complication rates with or without the use of bronchoscopy. Discontinuing the use of bronchoscopy in these procedures appears to be a safe, cost-effective alternative with reassuring outcomes and low complication rates.

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