Endoscopy is useful during percutaneous tracheostomy

Editor—Percutaneous tracheostomy is now well established in intensive care units in the United Kingdom.¹ Routine use of endoscopy during this procedure is less well established, and Susanto's comment that most percutaneous tracheostomies are done under endoscopic guidance requires comment.² A survey of intensive care units in the United Kingdom found that less than one third of units routinely used fibreoptic endoscopy during the procedure.¹

We reviewed seven papers published in 2000 or 2001 that either compared percutaneous tracheostomy with surgical tracheostomy or compared different methods of percutaneous tracheostomy. In only two of these studies was endoscopy routinely used.

The use of endoscopy may decrease as experience of the technique increases. In one prospective study of 100 cases endoscopy was used for the first 14 cases and then abandoned as a routine procedure.³

We use continuous fibreoptic endoscopy with a video display for all percutaneous tracheostomies. This allows assessment of the airway before the procedure and detection of complications during the procedure. How can early, initially subclinical, complications be detected if they are not looked for? Complications may occur because of components of the procedure that are common to many other techniques, such as intratracheal placement of the needle and guidewire, or because of the method of dilating the tract. Continuous endoscopic inspection may allow a distinction to be made between these complications.

Future studies of percutaneous tracheostomy should include endoscopy as a routine component of the procedure.