Pelosi, P.

Servillo, G.

Pelosi P.

Servillo G.

Archivio della ricerca - Università degli studi di Napoli Federico II

Vargas et al. Critical Care 2014, 18:448http://ccforum.com/content/18/4/448LETTERPercutaneous tracheostomy: it’s time for a sharedapproach!Maria Vargas1*, Paolo Pelosi2 and Giuseppe Servillo1See related research by Simon et al., http://ccforum.com/content/17/5/R258 and related letter by Rajendran and Hutchinson, http://ccforum.com/content/18/2/425In a previous issue of Critical Care, Simon and col-leagues [1] reported the incidence of death related topercutaneous tracheostomy (PT). Fatal complicationsoccurred in 31% of cases during the procedure and in49% of cases within the first week of the tracheostomy[1]. In a later issue of Critical Care, Rajendran andHutchinson [2] suggested the use of a checklist, adaptedfrom the World Health Organization (WHO) surgicalsafety checklist, to improve safety and reduce errors andharm related to the PT procedure in critical care.However, a recent observational study performed in 101hospitals in Ontario, Canada, did not find any reductionin mortality or complications after the implementationof the WHO checklist in more than 100,000 surgicalprocedures [3].* Correspondence: vargas.maria82@gmail.com1Department of Neurosciences, Reproductive and OdontosthomatologicalSciences, University of Naples “Federico II”, Naples, Via Pansini 16 – 80100,Naples, ItalyFull list of author information is available at the end of the articleTable 1 Shared clinical practice for percutaneous tracheostomFindings Most commonIndications Long-term mecTechniques Ciaglia single dTiming 7 to 15 days afInvolved physicians in percutaneous tracheostomy Intensivists; earNeck ultrasound evaluation Screening befoVentilation protocol Largely used wSedation protocol Largely used inAirway management Endotracheal tuFiberoptic bronchoscopy Largely usedDiameter of fiberoptic bronchoscope 3 to 5 mmIntraprocedural complications Minor bleedingThe analysis was of seven national surveys performed in France (where 152 intensivNetherlands (63), Spain (100), Switzerland (48), and the UK (197).© Vargas et al.; licensee BioMed CentralCommons Attribution License (http://creativecreproduction in any medium, provided the orDedication waiver (http://creativecommons.orunless otherwise stated.2014PT is widely used in critical care, although no clinicalguidelines have been developed to suggest the best prac-tice for this invasive and risky procedure. Surveys on PT,performed in different European countries, have shownthe presence of a shared clinical practice [4]. We thinkthat, lacking clinical guidelines to provide the bestavailable scientific evidence and to reduce inappropriatevariation in PT practice, a careful analysis of differentsurveys may suggest to physicians the most commonpractice associated with PT. Table 1 shows shared clin-ical practice for PT from an analysis of seven nationalsurveys performed in France (where 152 intensive careunits participated in the survey), Germany (505), Italy(130), The Netherlands (63), Spain (100), Switzerland(48), and the UK (197).y from an analysis of seven national surveys in Europepracticehanical ventilation, weaning failure, and upper airway obstructionilator and guide-wire dilating forcepster intensive care unit admission, nose, throat specialist; and general surgeonre the procedure to assess at-risk structureith volume-controlled ventilationassociation with local anesthesia, analgesia, and neuromuscular blockingbe in placee care units participated in the survey), Germany (505), Italy (130), TheLtd. This is an Open Access article distributed under the terms of the Creativeommons.org/licenses/by/4.0), which permits unrestricted use, distribution, andiginal work is properly credited. The Creative Commons Public Domaing/publicdomain/zero/1.0/) applies to the data made available in this article,Vargas et al. Critical Care Page 2 of 22014, 18:448http://ccforum.com/content/18/4/448AbbreviationsPT: percutaneous tracheostomy; WHO: World Health Organization.Competing interestsThe authors declare that they have no competing interests.Author details1Department of Neurosciences, Reproductive and OdontosthomatologicalSciences, University of Naples “Federico II”, Naples, Via Pansini 16 – 80100,Naples, Italy. 2Department of Surgical Sciences and IntegratedDiagnostics-IRCCS San Martino IST, University of Genoa, L.go R. Benzi16-1632, Genoa, Italy.Published:References1. Simon M, Metschke M, Braune SA, Puschel K, Kluge S: Death afterpercutaneous tracheostomy: a systematic review and analysis of riskfactors. Crit Care 2013, 17:R258.2. Rajendran G, Hutchinson S: Checklist for percutaneous tracheostomy incritical care. Crit Care 2014, 18:425.3. Urbach DR, Govindarajan A, Saskin R, Wilton AS, Baxter NN: Introduction ofsurgical checklist in Ontario, Canada. N Engl J Med 2014, 370:1029–1038.4. Vargas M, Servillo G, Arditi E, Brunetti I, Pecunia L, Salami D, Putensen C,Antonelli M, Pelosi P: Tracheostomy in intensive care unit: a nationalsurvey in Italy. Minerva Anestesiol 2013, 79:156–164.Cite this article as: Vargas et al.: Percutaneous tracheostomy: it’s time fora shared approach! Critical Care07 Jul 201410.1186/cc139742014, 18:448

PERCUTANEOUS TRACHEOSTOMY: IT’S TIME FOR A SHARED APPROACH!

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