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Background <p>Tracheostomy is a commonly performed procedure for patients requiring prolonged mechanical ventilation. It can be performed at the bedside using percutaneous dilatational tracheostomy (PDT) under bronchoscopic guidance (BG), which reduces the need for surgical tracheostomies. The aim of this study was to compare early versus late BG-PDT in terms of complications and survival.</p> Methods <p>This retrospective study included patients who underwent BG-PDT between 2012 and 2022 at the Pulmonary Institute of Rabin Medical Center. Data was collected by reviewing demographic and clinical parameters from electronic medical records, with a minimum follow-up of 24 months after the BG-PDT procedure. Early BG-PDT was defined as a procedure performed within 7 days of intubation and late PDT was performed from day 8 onward.</p> Results <p>A total of 207 BG- PDT procedures were performed between 2012 and 2022, of which 188 patients were included in the final analysis. The mean age of the patients was 69 years, with 57.5% being male. Patients who underwent early BG-PDT were younger (mean age 63 vs. 71, <i>p</i> &lt; 0.01).The most common indications for PDT were respiratory disorders (47.8%) and neurological disorders (19.1%). Patients in the early PDT group had a median overall hospitalization duration of 14 days post BG-PDT (IQR 21–31), compared to 33.5 days (IQR 26–47) in the late group (<i>p</i> &lt; 0.01). The overall 1-year survival rate was 54.3% in the early BG-PDT group versus 30.1% in the late BG-PDT group (<i>p</i> = 0.04). The overall 3-year survival for both groups was 24.2%, with 45.4% in the early BG-PDT group and 19.6% in the late BG-PDT group (<i>p</i> = 0.008). Younger age was found to correlate better survival (OR 1.05, 95% CI: 1.02–1.08, <i>p</i> &lt; 0.001) and a higher one-year (54.3% vs. 30%, <i>p</i> = 0.04) and 3-year survival rate of 45.4% in the early vs. 19.6% in the late (<i>p</i> = 0.008).</p> Conclusions <p>Bronchoscopy guided percutaneous dilatational tracheostomy is associated with shorter hospitalization duration and has possible survival advantages when performed within 7 days of intubation.</p>

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Hospitalization and survival following early vs. late percutaneous tracheostomy under bronchoscopic guidance: a retrospective analysis of 207 cases

  • 期刊论文

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  • 发表日期：

    2025年11月24日

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  • Evgeni Gershman,
  • Doron Hausner,
  • Ido Neuman,
  • Lev Freidkin,
  • Dror Rosengarten,
  • Mordechai R. Kramer

摘要

Background

Tracheostomy is a commonly performed procedure for patients requiring prolonged mechanical ventilation. It can be performed at the bedside using percutaneous dilatational tracheostomy (PDT) under bronchoscopic guidance (BG), which reduces the need for surgical tracheostomies. The aim of this study was to compare early versus late BG-PDT in terms of complications and survival.

Methods

This retrospective study included patients who underwent BG-PDT between 2012 and 2022 at the Pulmonary Institute of Rabin Medical Center. Data was collected by reviewing demographic and clinical parameters from electronic medical records, with a minimum follow-up of 24 months after the BG-PDT procedure. Early BG-PDT was defined as a procedure performed within 7 days of intubation and late PDT was performed from day 8 onward.

Results

A total of 207 BG- PDT procedures were performed between 2012 and 2022, of which 188 patients were included in the final analysis. The mean age of the patients was 69 years, with 57.5% being male. Patients who underwent early BG-PDT were younger (mean age 63 vs. 71, p < 0.01).The most common indications for PDT were respiratory disorders (47.8%) and neurological disorders (19.1%). Patients in the early PDT group had a median overall hospitalization duration of 14 days post BG-PDT (IQR 21–31), compared to 33.5 days (IQR 26–47) in the late group (p < 0.01). The overall 1-year survival rate was 54.3% in the early BG-PDT group versus 30.1% in the late BG-PDT group (p = 0.04). The overall 3-year survival for both groups was 24.2%, with 45.4% in the early BG-PDT group and 19.6% in the late BG-PDT group (p = 0.008). Younger age was found to correlate better survival (OR 1.05, 95% CI: 1.02–1.08, p < 0.001) and a higher one-year (54.3% vs. 30%, p = 0.04) and 3-year survival rate of 45.4% in the early vs. 19.6% in the late (p = 0.008).

Conclusions

Bronchoscopy guided percutaneous dilatational tracheostomy is associated with shorter hospitalization duration and has possible survival advantages when performed within 7 days of intubation.