Clinical Characteristics and Outcomes of Patients Managed with Percutaneous Dilatational Tracheostomy in the Intensive Care Unit: A Retrospective Observational Study

Abstract

Introduction: Percutaneous dilatational tracheostomy  has emerged as a preferred minimally invasive alternative to surgical tracheostomy for critically ill patients requiring prolonged mechanical ventilation, though comprehensive data from Nepal remains limited. This study aimed to evaluate the practice of percutaneous dilatational tracheostomy and analyze clinical outcomes in a tertiary level ICU in Nepal.

Methods: A retrospective observational study was conducted at Level III ICUs Nepal from April 14, 2021 to April 12, 2024. All patients aged 18 and older who underwent percutaneous dilatational tracheostomy during ICU stay in the study duration were included. Ethical approval for the study was obtained from the institutional review committee [Ref. 583. (6-11) E2]. Data on clinical characteristics, procedural techniques, complications, and outcomes were collected from electronic records and individual file records from hospital record department.

Results: The study population comprised predominantly males 53 (63.86%) with a median age of 49 (IQR: 30-62) years. Neurological disorders, particularly intracranial haemorrhage, were the most common admission diagnosis 53 (63.86%). The mean duration from mechanical ventilation to PDT was 16 (IQR: 11-20) days and the main indication was prolonged mechanical ventilation 62 (74.7%). Grigg’s guidewire dilator forceps technique was used 77 (92.77%) of the time. Immediate complications occurred in 12 (14.46%) of cases. The hospital survival rate was 42 (50.6%) with 69 % of survivors achieving decannulation before discharge.

Conclusions:Percutaneous dilatational tracheostomy safe bedside procedure for critically ill patients needing prolonged ventilation, with only minor, non-life-threatening complications observed in our tertiary care setting.