Safety of percutaneous dilational tracheostomy in patients ventilated with high positive end-expiratory pressure (PEEP)

Intensive Care Med. 2003 Jun;29(6):944-948. doi: 10.1007/s00134-003-1656-8. Epub 2003 Feb 13.


Objective: To assess the impact of bronchoscopically guided percutaneous dilational tracheostomy (PDT) on oxygenation in patients with severe respiratory failure ventilated with high positive end-expiratory pressure (PEEP).

Design: Prospective clinical study.

Setting: Anaesthesiological ICU, referral centre for acute respiratory distress syndrome (ARDS) therapy, university hospital.

Patients: Mechanically ventilated patients with indication for PDT. Two hundred three consecutive PDTs were performed in 198 patients on either high (>10 mbar, n=88) or low (</=10 mbar, n=115) PEEP under bronchoscopic guidance. Arterial blood gas tensions were measured immediately before and 1 and 24 h after PDT.

Results: Positive end-expiratory pressure averaged 16.6+/-4 mbar in the high PEEP and 7.6+/-2.2 mbar in the low PEEP group. In the high PEEP group the PaO(2)/FIO(2 )ratio was lower (243+/-90 vs 285+/-78 mmHg) and PaCO(2) higher (45+/-9.4 vs 39+/-7.1 mmHg) when compared to the low PEEP group. Nevertheless, PDT did not significantly decrease oxygenation in either group 1 and 24 h after PDT (PaO(2)/FIO(2): 223+/-83 and 260+/-86 mmHg in the high PEEP group and 280+/-88 and 302+/-82 mmHg in the low PEEP group, respectively). Furthermore, oxygenation did not deteriorate with PDT even in patients with gravely impaired gas exchange (lowest quartile) with a PaO(2)/FIO(2) averaging 130+/-42 mmHg (range 45-192 mmHg) at a PEEP of 17+/-4 mbar.

Conclusions: Bronchoscopically guided PDT in our patients on high PEEP did not jeopardise oxygenation 1 h and 24 h following PDT. Accordingly, high PEEP and hypoxic respiratory failure should not be considered a general contraindication for PDT.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Analysis of Variance
  • Blood Gas Analysis
  • Bronchoscopy / adverse effects
  • Bronchoscopy / methods*
  • Dilatation / adverse effects
  • Dilatation / methods*
  • Hemorrhage / etiology
  • Humans
  • Middle Aged
  • Partial Thromboplastin Time
  • Patient Selection
  • Platelet Count
  • Pneumothorax / etiology
  • Positive-Pressure Respiration / adverse effects
  • Positive-Pressure Respiration / methods*
  • Prospective Studies
  • Prothrombin Time
  • Pulmonary Gas Exchange
  • Respiratory Insufficiency / metabolism
  • Respiratory Insufficiency / therapy*
  • Safety
  • Severity of Illness Index
  • Time Factors
  • Tracheostomy / adverse effects
  • Tracheostomy / methods*
  • Treatment Outcome