Abstract Rationale Percutaneous dilatational tracheostomy (PDT) is a common procedure performed in intensive care units (ICU) by intensivists, surgeons, pulmonologists, and anesthesiologists. While PDT has been shown to have favorable outcomes and complication rates comparable to surgical tracheostomy, limited data exist on the bedside placement of extended-length tracheostomy (XLT) tubes, often selected for patients with anatomical challenges, such as increased skin-to-trachea distance, obesity, tracheal stenosis, or tracheomalacia. Methods We identified 538 patients who underwent bedside percutaneous tracheostomy placement at Georgetown University Hospital from July 2010 to July 2024 using billing records cross-referenced with procedural group logs, including 50 proximal XLT and 488 standard tracheostomy placements. Propensity score for receiving an XLT was calculated using logistic regression with the following covariates: body mass index (BMI), age, gender, SOFA score on the day of the procedure, pre-procedure FiO2, and pre-procedure positive end-expiratory pressure (PEEP). We used optimal 2:1 matching without replacement to minimize global distance while retaining all XLT cases, resulting in 50 XLT cases and 100 standard tracheostomy controls. Covariate balance was evaluated using standardized mean differences (SMD), with all SMD across key clinical variables below 0.2 except for BMI (SMD 0.28). The primary outcomes were procedural complications: pneumothorax, pneumomediastinum, immediate bleeding (with and without transfusion), worsening hypoxemia, and immediate mortality. Results Procedural complications were infrequent and similar across groups. Immediate bleeding occurred in 5 of 50 XLT cases (10%) and 11 of 100 standard cases (11%) (p = 0.88); bleeding requiring transfusion occurred in 1 (2%) and 2 (2%) of cases, respectively (p = 0.94). Worsening hypoxemia within one hour of the procedure occurred in 3 (6%) XLT cases and 6 (6%) standard cases (p = 0.97). There was one pneumothorax in the standard group and none in the XLT group. Pneumomediastinum occurred in one case in each group. No immediate deaths were observed in either group. The composite rate of any procedural complication was 10% in the XLT group and 11% in the standard group (p = 0.91). No procedures were aborted or converted to open tracheostomy due to anatomic or airway difficulties. Conclusions Bedside placement of percutaneous XLT tubes is safe and feasible, with complication rates comparable to standard tracheostomy placement despite being used in more anatomically complex, often obese patients. Matching achieved close covariate balance, and complication rates were low and statistically similar. These findings support the continued placement and use of bedside XLT tracheostomy for appropriately selected ICU patients. This abstract is funded by: None
Kim et al. (Fri,) studied this question.