Safety of endoscopic guided percutaneous dilation tracheostomy

Riga East university hospital to date is the only center in Latvia to perform endoscopic guided percutaneous tracheostomy. The objective of the study was to assess the indication, length of the procedure and early complications of endoscopic guided percutaneuous dilation tracheostomy. A retrospective study at Riga East University hospital was performed and involved patients for whom the data of percutaneous dilation tracheostomy (PDT) during the time period of 2004 – 2019 was available. The procedure was performed in ICU setting at the bedside. All the PDT were performed using Griggs technique and commercial Portex kit, all procedures were done under bronchoscopic guidance.  400 patients’ cases were available for analysis, 62% of them were male (247) and 38% (153) were female. The mean age of the patients was 53,9 ± 18,1 years. The most common reason for the PDT were neurological deficit (52%) and prolonged mechanical lung ventilation (23%). The diagnosis of patients for need of ICU were variable – most commonly due to sepsis (21%), polytrauma (13%) and oncology (8%).  The mean duration of the procedure was 5,5 ± 2,8 minutes (ranging from 2 to 20 minutes). The early complications rate was low (8%) and consistent mainly of minor bleeding in 4,5% of the cases, moderate bleeding was seen only in 1% cases mainly due to coagulation problems, in 1,5% - minor desaturation, 1,5% hypotension during anesthesia, in 0,25% cases – tracheal ring fracture and pneumothorax In our center in ICU setting the PDT with endoscopic guidance is the method of choice that has been proven to be even more important in COVID19 era. Endoscopic guided percutaneous tracheostomy is safe and relatively quick procedure with low complication rate, that shows it can be safely performed in ICU at bedside.