Percutaneous Tracheostomy – Advantages and Complications

Percutaneous tracheostomies, of any technique, have become an essential procedure in the ICU setting, especially in patients for which we expect a need for prolonged invasive ventilatory support. Percutaneous tracheostomies are very efficient, relatively easily performed and thus need to be an essential skill for every intensivist. Experience in setting an indication and timing is as equally important as the manual skill required for the procedure. Based on our experience of over 300 performed percutaneous tracheostomies, we recommend performing the procedure at an earlier phase, up to seven days from intubation, in order to reduce the risks associated with prolonged intubation such as tracheal stenosis, tracheo-oesophageal fistula formation and ventilator associated pneumonia. As with every invasive procedure, there are advantages and complications. Implementing a standardized protocol for this procedure increases the rate of success and safety of the patient. Based on available data, percutaneous tracheostomies have certain definite advantage points in comparison to a classical surgical tracheostomy and should therefore be recommended as a safe method of treatment, having in mind that a classical surgical tracheotomy has its indications which must not be overlooked.