Can mini-tracheostomy needle be safer for residency training in percutaneous dilatation tracheostomy applications in intensive care unit?

Abstract

Aim: The aim of this study is to evaluate the bedside percutaneous dilatation tracheostomy (PDT), performed with fiberopticbronchoscopy guided Griggs technique using a mini-tracheostomy needle, by residents in intensive care unit (ICU)retrospectively.Material and Method: Twenty PDT applications were performed in ICU using mini-tracheostomy needle in the present study. AllPDT procedures were performed by a resident who was currently undergoing ICU residency training. Griggs technique was usedin all procedures. All complications, the time from needle insertion to the insertion of the tracheostomy cannula was also noted.Results: The average age of the patients was 69.8±16.14 years. The mean Acute Physiology and Chronic Health Assessment(APACHE) II score of the patients was 23.05±6.16, Glasgow Coma Scale (GCS) score was 10±3.43, and Sepsis-Related OrganFailure Assessment (SOFA) score was 7.2±2.11. The mean procedure time was 13±1.68 minutes, and the day of tracheostomyapplication was 6.35±4.59. Twelve (60%) patients were switched to home-type ventilators. Ten (50%) of the patients weretransferred to the palliative ward with home-type ventilator. Mortality rate was 20% (4 patients) at 90 days. When patients wereevaluated in terms of complications; none of the patients had pneumothorax, subcutaneous emphysema, posterior trachealwall damage, or tracheoesophageal fistula. Minimal bleeding that required no intervention was observed in only one patient.Conclusion: Using mini-tracheostomy needle in PDTs performed via fiberoptic bronchoscopy by less experienced residentsmay be safer to prevent complications.