Evaluation of bronchoscopic-assisted percutaneous tracheostomy

The convenience of bedside percutaneous tracheostomy (PT) is growing in popularity. Some centers are placing PTs without the assistance of bronchoscopy. The study objective was to identify operative and perioperative problems with PT placement and to identify potential problems with bronchoscopy-free placement. All operative and perioperative events were prospectively recorded as a performance improvement project at our institution while performing bronchoscopic-assisted bedside PTs. One hundred eighty-three patients underwent PT placement, all with the assistance of a bronchoscope. Although most PT was performed without incident, some of the complications can be severe. The majority of difficulties can be prevented with bronchoscopic assistance. An unexpected procedural difficulty that has not been previously reported is the dilatational difficulty in the younger patient population. Some of these patients required an additional tracheal incision with a scalpel. This may be from a healthy pretracheal fascia and/or musculature.