Introduction: Percutaneous tracheostomy is widely used in critically ill patients, but questions remain about its optimal timing, technique, and risk stratification. This study aimed to describe the epidemiological and clinical profile of ICU patients undergoing percutaneous tracheostomy in the Costa Rican public health system and to identify predictors of acute complications.
Methods: We conducted a prospective, multicenter observational study in eight CCSS hospitals from February 2019 to December 2022. Adult ICU patients who underwent percutaneous tracheostomy were included. Data on demographics, clinical status, procedural characteristics, and perioperative complications were collected. Multivariable logistic regression identified predictors of adverse outcomes.
Results: Among 516 patients (mean age 53.2 ± 16.3 years; 68.2% male), the main indications were anticipated prolonged ventilation (32.4%), neurological deficits (26.7%), and ventilation >10 days (21.8%). Modified Ciaglia and Griggs techniques were used in 51% and 48.3%, respectively. Capnography was employed in 74.2%, ultrasound in 17.7%, and bronchoscopy in 3.1%.
Overall, 28.3% experienced acute complications—most commonly minor bleeding (25.4%). Serious events (airway loss, false passage, or surgical bleeding) occurred in 3.9%. No procedure-related deaths were reported. First-pass success was achieved in 85.1% of cases. Use of capnography was associated with lower complication risk (OR 0.45; 95% CI 0.20–0.99). Risk factors included anticoagulation (OR 2.82), obesity (OR 2.10), coagulopathy (OR 2.29), cervical immobilization (OR 4.68), prior neck surgery (OR 3.49), and technical difficulty (OR 2.00 for any complication; OR 4.15 for serious ones). Airway management by physicians (vs. respiratory therapists) was linked to higher complication rates (OR 1.54).
Conclusions: Percutaneous tracheostomy in Costa Rican ICUs is a safe and effective intervention, with a low incidence of serious complications and no procedure-related deaths. Technical optimization—including capnography monitoring and preprocedural risk assessment—may further reduce adverse outcomes, especially in patients with high-risk features.
