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CRITICAL CARE AND TRAUMA

Tracheostomy in the Intensive Care Unit: A Nationwide Survey

Stefan Kluge, MD^*, Hans Jörg Baumann, MD, Claudia Maier, MD^*, Hans Klose, MD, Andreas Meyer, MD, Axel Nierhaus, MD^*, and Georg Kreymann, MD^*

From the Departments of *Intensive Care; and Pulmonary Medicine, University Medical Center, Hamburg-Eppendorf, Germany.

Address correspondence to Stefan Kluge, MD, Department of Intensive Care, University Medical Center, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Address e-mail to skluge{at}uke.uni-hamburg.de.

BACKGROUND: The indication, timing and technique of tracheostomy have changed over the last several years. We performed a survey to assess the current practice of tracheostomy in German intensive care units (ICUs).

METHODS: A postal questionnaire was sent to the head physicians of 513 German ICUs, excluding pediatric ICUs.

RESULTS: We obtained responses from 455 of the 513 ICUs (89%). In 90% of the ICUs, tracheostomies were performed during the first 14 d of mechanical ventilation. Eighty-six percent of the ICUs routinely performed percutaneous dilatational tracheostomy; the modified Ciaglia technique was the most popular percutaneous technique (69%). The majority (98%) of the percutaneous procedures were performed under bronchoscopic control. Surgical tracheostomy is usually performed in the operating room (72%) by a surgeon (61%), whereas percutaneous dilatational tracheostomies are usually performed at the patient's bedside in the ICU (98%) by an intensivist (93%). Tracheostomized patients were followed up routinely in 26% of the ICUs, and in 45% of the ICUs there were guidelines regarding the indication, the timing and the technique of tracheostomy.

CONCLUSION: Percutaneous dilatational tracheostomy is the procedure of choice for tracheostomy in critically ill patients in Germany. The modified Ciaglia technique is the preferred percutaneous technique, and nearly all physicians routinely use bronchoscopic guidance. Most tracheostomies are done during the second week of mechanical ventilation.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999