(1031) Safety of Percutaneous Dilatational Tracheostomy in Neuro-ICU Patients

Introduction: The most popular technique for ICU patients is the percutaneous dilatational tracheostomy (PDT) which uses serial dilators over a guide wire and is usually done at the bedside in the intensive care unit (ICU) under bronchoscopic guidance. PDT is commonly performed by surgeons, and medical intensivists. Its safety and efficacy in the specific population of NeuroICU patients, who often present unique challenges and complexities, have not been extensively investigated. This study aims to evaluate the safety of PDT in NeuroICU patients when performed by neurointensivists.

Methods: NIs were credentialed for PDT based on American College of Chest Physicians
guidelines for training and credentialing that recommend a minimum of 20 procedures. Data were extracted from electronic health record (EPIC). Intra-operative complications (IOC) included bleeding, cardiac arrest, extubation, tracheal tear or abrasion, paratracheal insertion, pneumothorax, and need to convert to surgical tracheostomy. Post-operative complications (POC) included bleeding, accidental dislodgement, and infection at stoma site treated with antibiotics. Bleeding is defined as requiring surgical intervention or transfusion of RBC, FFP, or platelets.

Results: A total of 153 PDTs were identified and analyzed with the following diagnoses (TBI 57 %, SCI 13 %, ICH 10%, Ischemic Stroke 6%, SAH 6 %, anoxic brain injury 4 %, and SDH 4 %). Average age was 50 +/- 23 years, gender (72 % male), and BMI (27 +/- 6). IOC was 2.6 % (2 % paratracheal insertion, and 0.6 % converted to surgical tracheostomy). POC was 2 % (accidental dislodgement requiring bedside replacement). Disposition included alive to home (22 %), alive to long-term facility or rehab (69 %), and dead (9 %).

Conclusions: In a large single center, PDT performed by appropriately trained and credentialed neurointensivists appears to be a safe procedure, offering potential benefits in terms of optimal airway management and patient outcomes. Further research is necessary to establish standardized protocols, refine patient selection criteria, and optimize safety practices to ensure the best possible outcomes for this vulnerable patient population.