Kornblith et al identified patients in the surgical intensive care unit (SICU) who are at increased risk when undergoing a bedside percutaneous tracheostomy. This form of tracheostomy is relatively safe even when several risk factors are present. The authors are from Denver Health Medical Center and the University of Colorado in Denver.


Patient selection: surgical intensive care unit


A high risk patient had one or more of the following risk factors:

(1) cervical collar or halo

(2) traumatic injuries to the cervical spine

(3) systemic heparinization (or other anticoagulation)

(4) positive end-expiratory pressure (PEEP) > 10 cm H2O

(5) FIO2 > 50%


Most high risk patients have only one risk factor but 44% had 2 or more.


Early complications for the procedure (regardless of risk level):

(1) bleeding

(2) infection

(3) misplacement of the tracheostomy tube

(4) failure of procedure with need for cricothyroidotomy


Late complications:

(1) persistent stoma requiring surgical closure

(2) subglottic stenosis


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