A study on the effects of bronchoscopy in preventing the possible complications of percutaneous tracheostomy with griggs technique, which has been applied in emergency department intensive care unit

Aim: Tracheostomy in early phase of hospitalization is recommended especially for patients in intensive care units with prolonged endotracheal intubation and who needs mechanical ventilation. In our study we aimed to specify the clinical effects and the efficacy of the flexible fiberoptic bronchoscopy, which is performed to maintain a surgical airway with Griggs technique percutaneous tracheostomy application in the intensive care unit of the Department of Emergency Medicine, in preventing the possible complications and determining the complications on early stages. Materials and Method: The study was initiated after the approval of the local ethics committee, between the dates of June 2013 and March 2015, in the Intensive Care Unit of the Abant Izzet Baysal University School of Medicine, Department of Emergency Medicine. Prospectively, patients who were intubated for various reasons and those needed respiratory support for a long term, were included in the study. Data were collected regarding the patients who had undergone Griggs technique percutaneous dilatational tracheostomy with flexible fiberoptic bronchoscopy. Results: Twenty female (mean age: 73.9±15.0 years) and twenty male (mean age: 71.5±14.8 years) subjects who were hospitalized in the Intensive Care Unit of the Department of Emergency Medicine, between the dates of June 2013 and March 2015, were included in the study. Period of intubation for patients prior to the tracheostomy was mean of 15.4±9.4 days. No statistical differences were observed regarding the hemoglobin levels and arterial blood gas values of the patients prior to and after the tracheostomy. No complications were reported during the intervention for 31 patients who undergone tracheostomy. In one of the nine patients with complication, cannula cuff ruptured due to very difficult placement of the cannula. Slight hemorrhages and mild difficulties during cannula placement were experienced in rest 8 patients due to adversities whilst the percutaneous dilatation. In none of our subjects any major complications like injury of posterior tracheal wall, wrong subcutaneous passage, emphysema or pneumothorax were occurred. Conclusion: Flexible fiberoptic bronchoscopy was found to be efficient in preventing posterior tracheal wall injury which is known to be one of the most important complications during the Griggs technique percutaneous tracheostomy application; and in preventing post-intervention early hemorrhage and also in detecting cannula malpositions. We highly recommend the use of a flexible fiberoptic bronchoscope, during an intervention for a surgical airway via percutaneous tracheostomy application with the "Griggs technique".