Intervention Percutaneous tracheostomy: a review of 2 cases

Background: Percutaneous tracheostomy to a large extent has replaced conventional surgical tracheostomy by virtue of its low incidence of complications and the rapidity with which the procedure can be performed at the bedside avoiding transport of critically ill patients to the operating rooms. Since it is a blind approach, bronchoscopic guidance has been suggested which is not always possible because of economic constraints. Methods: A case study of 2 patients who had guide wire dilating forceps technique of percutaneous tracheostomy without the aid of a bronchoscope have been reported here. By ensuring the free mobility of the guide wire at each step of the procedure, a safe placement of the tracheostomy tube was achieved. Results: The mean operating time in both the cases was nearly 6 mins. Both the patients did not have any complications. Both the patients were tracheotomised for permanent indication. One had severe dysphagia and TEF and could not survive long even after feeding gastrostomy. Other patient was referred to radiotherapy for stage IV supraglottic carcinoma larynx. Conclusions: In the absence of bronchoscopic guidance, adopting the simple but effective precaution of free movement of guide wire at each step of the procedure, a safe tracheostomy tube placement is possible in an emergency as described in our report.