Percutaneous Dilatational Tracheostomy Performed by Anaesthesiologist in a Low Resource Setting: Preliminary Report on 19 Patients

Abstract

Background: Percutaneous dilatational tracheostomy (PDT) is an established alternative to surgical tracheostomy in intensive care patients deemed to require prolonged ventilation. The procedure is simple, cheap and is associated with less complication. Even though PDT is the preferred technique of tracheostomy in ICU’s in low resource countries like Ghana little is known about this technique. PDT using the percutwist set became available in the ICU of the Komfo Anokye Teaching Hospital recently and we report on 19 consecutive cases done so far.
Objective: To determine the outcome of 19 percutaneous dilatational tracheostomy done under bronchoscopic guidance by anaesthesiologists in an Intensive Care Unit.
Design: Retrospective study. 

Setting: Intensive Care Unit of the Komfo Anokye Teaching Hospital, Kumasi, Ghana
Subjects and Methods: Nineteen consecutive patients who underwent percutaneous dilatational tracheostomy at the bedside
using the percutwist set under bronchoscopy guidance. Using the admission/discharge books and the Nurses report book in the ICU, patients’ records were retrieved. The number and success of tracheostomies, and the complications were assessed.
Results: There were 19 patients who underwent PDT during the period. 17 (95.24%) of the tracheostomies done were successful with easy ventilation of the lungs In one patient (4.76%) PDT was unsuccessful and was converted to surgical tracheotomy. One patient had a problem with ventilation after the tracheostomy tube was inserted. It was detected that the tube was short and was therefore replaced with a normal endotracheal tube. There was bleeding from the incision site in two of the patients (9.5%). This was controlled with pressure dressing.
Conclusion: In a low resource country like Ghana where there is a limited number of ENT surgeons, PDT performed by the anaesthesiologist in the ICU can be an alternative technique to surgical tracheostomy. It is safe and success rate is high if done by skilled Anaesthesiologist in the appropriate patient.