Safety of Fiberoptic Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy in Critically Ill Patients: A Single-Center Prospective Study

Background: Percutaneous dilatational tracheostomy (PDT) is widely used in intensive care units (ICUs) as an alternative to surgical tracheostomy. However, procedure-related complications remain a concern. Fiberoptic bronchoscopy (FFB) has been proposed as a guidance technique to improve procedural safety. This study aimed to evaluate the safety and clinical outcomes of bronchoscopy-guided percutaneous dilatational tracheostomy in critically ill patients. Methods: This prospective observational study was conducted in the Emergency Intensive Care Unit of a tertiary university hospital between January 2014 and December 2016. A total of 40 adult patients who required prolonged mechanical ventilation and tracheostomy were included. All tracheostomy procedures were performed using the Griggs technique under fiberoptic bronchoscopy guidance. Demographic data, Sequential Organ Failure Assessment (SOFA) scores, laboratory parameters, arterial blood gas measurements, and procedural complications were recorded. Hematological and coagulation parameters before and after the procedure were compared, and complication rates were analyzed. Results: Forty patients (20 female, 20 male) with a mean age of 72.7 ± 14.7 years were included. The mean duration of intubation before PDT was 15.4 ± 9.4 days. No major complications such as pneumothorax, posterior tracheal wall injury, false passage, or massive hemorrhage were observed. Minor complications occurred in nine patients (22.5%), most commonly minor bleeding around the stoma. Hematocrit levels showed a small but statistically significant decrease after the procedure (p = 0.035). Arterial blood gas parameters did not show significant changes across measurements performed before, during, and after the procedure (p > 0.05). Conclusion: Bronchoscopy-guided percutaneous dilatational tracheostomy appears to be a feasible bedside procedure in critically ill patients and was associated with a low rate of mostly minor complications in this cohort. Real-time bronchoscopic visualization may contribute to procedural safety by facilitating accurate cannula placement. However, larger prospective multicenter studies are needed to confirm these findings.