Evaluation of Rigid Bronchoscopy–Guided Percutaneous Dilational Tracheostomy. A Pilot Study

Abstract

Rationale: Rigid bronchoscopy–guided (RBG) percutaneous tracheostomy has been used in patients with morbid obesity, prior neck surgery, distorted airway anatomy, and uncorrected coagulopathy where standard percutaneous dilational tracheostomy (PDT) is relatively contraindicated. Objectives: This study aims to describe a standardized approach to incorporate RBG-PDT in clinical practice. Methods and Measurements: Retrospective case series of patients who underwent RBG-PDT from 2008 to 2012 at Beth Israel Deaconess Medical Center. Patient medical records were reviewed for demographics, comorbid conditions, American Society of Anesthesiologists classification, indication for tracheostomy, duration of procedure, and periprocedural complications. Main Results: A total of 35 patients underwent RBG-PDT, including 24 men, with a mean age of 66 years (611 yr; range, 42–88 yr). The mean body mass index was 34 kg/m2. The mean procedure time was 32 (610) minutes, with a median of 33 minutes. The most common indication for tracheostomy was failure to wean from mechanical ventilation, followed by tracheal stenosis and tracheobronchomalacia. The most common indications for RBG-PDT were complex airway, obesity, and coagulopathy. There were no periprocedural complications of consequence, or mortality associated with the procedure. Conclusions: RBG-PDT is safe and effective in a population of high-risk patients who are otherwise not considered good candidates for standard PDT.