Bedside percutaneous dilatational tracheostomy in patients outside the ICU: a single-center experience

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Purpose:To assess the safety of medical-ward bedside percutaneous dilatational tracheostomy (GWB-PDT).Materials and methods:A retrospective study of all patients who underwent elective GWB-PDT between 2009 and 2015. A joint otolaryngology–ICU team performed all GWB-PDTs. The patients were followed until decannulation, discharge or death. Complications were divided into early (within 24 h) and late, and into minor and major.Results:Two hundred and fifty six patients were included in the study. The mean age was 77.7 ± 11.8 Medical history included cardiac comorbidities (42.6%) and cerebrovascular accidents (34.4%). Overall, 48 patients (18.9%) had 60 complications, of which 70% (42/60) were minor (13 early; 29 late complications). Fifteen patients (5.9%) had major complications. Eight patients had early major complications (loss of airway – two patients [0.8%], pneumothorax – two patients [0.8%], resuscitation - one patient [0.4%], and a single patient (0.4%) died within 24 h following PDT). Two additional patients (0.8%) underwent conversion to an open tracheostomy. Seven patients had late complications (airway complications in six patients [2.3%] and major bleeding in a single patient [0.4%]). Of the seven patients with late major complications, three had two major complications. Half of the complications occurred by POD 3.Conclusion:GWB-PDT is a feasible and safe solution for tracheostomies in general-ward ventilated patients.HighlightsShortage in ICU beds resulted in intermediate care units and medical wards' ventilated patients.These patients are characterized by older age and higher frailty compared with ICU patients.Medical ward bedside percutaneous tracheostomy is conducted by a joint ICU-otolaryngology team.MWB-PDT can be performed with an acceptable rate of complications despite non-ideal conditions.

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