Deciding when to use percutaneous dilatational tracheostomy

Percutaneous dilatational tracheostomy (PDT) is a safe, minimally invasive procedure that can be performed at bedside in the ICU. The indications for PDT are the same as for surgical tracheostomy and include prolonged intubation, assistance in weaning from mechanical ventilation, upper airway obstruction, and facilitation of removal of respiratory secretions. Preprocedure evaluation includes a review of pertinent history, a detailed physical examination focusing on neck anatomy and extension, and assessment of ventilatory status. Coagulation abnormalities and bleeding tendencies are identified by checking platelet count, partial thromboplastin time, prothrombin time/international normalized ratio, and renal function. Advantages of PDT include elimination of the risky transport of critically ill patients out of the ICU, short waiting time once the decision to perform a tracheostomy has been made, and significant cost reduction. Less postoperative bleeding and infection may be seen with PDT than with surgical tracheostomy.