In a previous issue of Critical Care, Simon and colleagues [1] reported the incidence of death related to percutaneous tracheostomy (PT). Fatal complications occurred in 31% of cases during the procedure and in 49% of cases within the first week of the tracheostomy [1]. In a later issue of Critical Care, Rajendran and Hutchinson [2] suggested the use of a checklist, adapted from the World Health Organization (WHO) surgical safety checklist, to improve safety and reduce errors and harm related to the PT procedure in critical care. However, a recent observational study performed in 101 hospitals in Ontario, Canada, did not find any reduction in mortality or complications after the implementation of the WHO checklist in more than 100,000 surgical procedures [3].
PT is widely used in critical care, although no clinical guidelines have been developed to suggest the best practice for this invasive and risky procedure. Surveys on PT, performed in different European countries, have shown the presence of a shared clinical practice [4]. We think that, lacking clinical guidelines to provide the best available scientific evidence and to reduce inappropriate variation in PT practice, a careful analysis of different surveys may suggest to physicians the most common practice associated with PT. Table 1 shows shared clinical practice for PT from an analysis of seven national surveys performed in France (where 152 intensive care units participated in the survey), Germany (505), Italy (130), The Netherlands (63), Spain (100), Switzerland (48), and the UK (197).
Table 1.
Shared clinical practice for percutaneous tracheostomy from an analysis of seven national surveys in Europe
| Findings | Most common practice |
|---|---|
| Indications |
Long-term mechanical ventilation, weaning failure, and upper airway obstruction |
| Techniques |
Ciaglia single dilator and guide-wire dilating forceps |
| Timing |
7 to 15 days after intensive care unit admission |
| Involved physicians in percutaneous tracheostomy |
Intensivists; ear, nose, throat specialist; and general surgeon |
| Neck ultrasound evaluation |
Screening before the procedure to assess at-risk structure |
| Ventilation protocol |
Largely used with volume-controlled ventilation |
| Sedation protocol |
Largely used in association with local anesthesia, analgesia, and neuromuscular blocking |
| Airway management |
Endotracheal tube in place |
| Fiberoptic bronchoscopy |
Largely used |
| Diameter of fiberoptic bronchoscope |
3 to 5 mm |
| Intraprocedural complications | Minor bleeding |
The analysis was of seven national surveys performed in France (where 152 intensive care units participated in the survey), Germany (505), Italy (130), The Netherlands (63), Spain (100), Switzerland (48), and the UK (197).
Abbreviations
PT: percutaneous tracheostomy; WHO: World Health Organization.
Competing interests
The authors declare that they have no competing interests.
See related research by Simon et al., http://ccforum.com/content/17/5/R258 and related letter by Rajendran and Hutchinson, http://ccforum.com/content/18/2/425
Contributor Information
Maria Vargas, Email: vargas.maria82@gmail.com.
Paolo Pelosi, Email: ppelosi@hotmail.com.
Giuseppe Servillo, Email: servillo@unina.it.
References
- Simon M, Metschke M, Braune SA, Puschel K, Kluge S. Death after percutaneous tracheostomy: a systematic review and analysis of risk factors. Crit Care. 2013;17:R258. doi: 10.1186/cc13085. [DOI] [PMC free article] [PubMed] [Google Scholar]
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