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The following is a summary of “Safety and Efficacy of Rigid Bronchoscopy-guided Percutaneous Dilational Tracheostomy,” published in the January 2025 issue of Journal of Bronchology & Interventional Pulmonology by Murn et al.
Percutaneous dilational tracheostomy (PDT) was commonly performed by a wide range of practitioners and, barring relative contraindications, was preferred over surgical tracheostomy for patients with critical illness.
Researchers conducted a retrospective study to assess the effectiveness of rigid bronchoscopy-guided (RBG) PDT in providing a secure airway, ensuring unobstructed ventilation, protecting the posterior membrane from puncture, and enhancing suction capacity.
They analyzed individuals who underwent RBG-PDT between 2008 and 2023 at Beth Israel Deaconess Medical Center in Boston, Massachusetts. Electronic medical records were reviewed to collect preprocedural demographic data, procedural details, and postprocedural outcomes.
The results showed that 104 individuals underwent RBG-PDT over 15 years. The median age was 61.95 years (95% CI: 59.00-64.90), and the median BMI was 30.25 kg/m2 (IQR: 23.6-37.2), with 41.9% (32.5%-51.3%) having a BMI over 30 kg/m2. The procedure was performed on average 13.7 days after intubation, with 70% requiring it due to prolonged mechanical ventilation from respiratory failure. At least 1 increased bleeding risk factor was present in 51.0%, with prolonged activated aPTT >36 seconds being the most frequent (36.5%). Tracheostomy was conducted under ongoing therapeutic anticoagulation with heparin in 26.9%. Concurrent percutaneous endoscopic gastrostomy (PEG) tube placement occurred in 60.6%. No cases of pneumothorax or airway loss during endotracheal tube exchange for rigid tracheoscopy were reported.
Investigators concluded that RBG-PDT was a safe and effective procedure that expanded the patient population suitable for PDT when performed by an experienced Interventional Pulmonology team.
