No. Fibreoptic bronchoscopy is a very useful aid in the correct placement of tracheostomy tube with reduced complications. Only disadvantage is that you will need an experienced scopist (normally the intensive care colleagues) but it is worth having one present during the insertion.

I agree with Palanikumar. Most of PDT in our ICU are performed with endoscopic guidance/control to reduce major complications like perforation of the posterior tracheal wall, bleedings, cartilage rupture or tracheal tube misplacement.

My second prefered technique especially in patients with short neck is changing to a laryngeal tube and puncture of the trachea with ultrasound guidance. Nevertheless after tracheostomy a bronchoscopic control is done to exclude above mentioned complications.

Although some groups claim that PDT is safe without bronchscopic guidance it increases patient's safety. If you have it - use it.

You can compare this discussion with the threat about ultrasound guided central venous cath introducing. Landmark guided insertion can be safe in experienced hands but ultrasound can decrease complication rate even more.

I agree that performing PDT with bronchoscopy may decrease the risk of complications, especially paratracheal cannulation and lost airway. In addition demonstrating correct cannulation of the trachea is useful when the technique is taught to new operators. If the bronchoscopic picture is continuously displayed on a large screen, the team may follow the cannulation, dilatation and the tube insertion. We do not perform PDT at our ICU without bronchoscope, but I agree that “If you have it – use it”, and if you don’t, I would still do PDT if the alternative is surgical open tracheotomies.

If a person experienced in PDT is present, bronchoscopy is not mandatory, as the bronchoscopist must share the limited area available to the anesthesiologist managing the endotracheal tube during the procedure. In our ICU, over 500 PDTs have been performed during the last 10 years without major complications.

No, FB is an essential component of percutaneous tracheostomy. If the kit is incomplete

…rate of complications is bound to rise….

I agree, the flexible bronchoscopy not only prevents the complications but also is a guide to place the PDT in midline. there have been instances where though the PDT were in trachea , they were placed in para sagittal midline which reduces the airway space post decannulation.

in short fat neck I would still recommend a bedside conventional tracheostomy to do a precise job.

Bronchoscopy is (if at all available) mandatory to reduce complication rates while performing PDT. In my personal ranking having a bronchoscope at all and being able to handle it properly is more important for an ICU doctor than to perform PDTs.

As mentionend above, it is helpful in teaching the procedure.

Especially in younger patients with more elastic tracheal cartliages, I doubt that the use of ultrasound, anatomic landmarks or capnometry is sufficient to safely avoid lacerations of the pars membranacea or eccentric placement of the cannula.

I don't understand the point broad up by Dr. Papanikolaou that one bronchoscopist and one anaesthesist compete for the available space left at the patient's head. Usually, the person performing the bronchoscopy will take care of the tube handling.

Bonchoscopic guided Percutaneous dilatational tracheostomy (PDT) technique is safe and there is less risk of major and minor complications. So it has to be used if available but if its not there, PDT can be done without using it and i'll prefer it over conventional open tracheostomy for ICU patients.

We have performed more than 1000 percutaneous trachestomies without bronchoscopy aid and no significative complications but i must confess that in the last year (since we use bronchoscopy as part of the trachestomy protocol) we have even less technical problems and we have the subjective impression that we perform the technique more safely.