Percutaneous Tracheostomy

Percutaneous dilatational tracheostomy (PDT) is one of the commonly performed bedside procedures in critically ill patients by intensivists. PDT has become the standard of care in modern intensive care unit (ICU) and is not only safe but also has resulted in sharp decline in use of surgical tracheostomy barring a few selected cases. The foremost goal of PDT is to establish a safe airway in patients who cannot either protect their airway and/or require prolonged mechanical ventilation (MV). Other advantages include improved airway clearance and oral hygiene, efficient nursing care, better patient comfort and effective communication. Intended benefits of doing early tracheostomy in neurological patients entail reduced need for sedation, easier and faster weaning, and thereby shorter duration of MV, reduced ventilator associated pneumonia (VAP) rates, and reduced length of ICU stay contributing to better outcomes [2]. There are special considerations of PDT in neurocritical care patients including TBI, cervical spine injury, and pediatric neurological patients due to their underlying pathology which must be properly addressed.