A national survey on percutaneous tracheostomy practice in Malaysian adult general intensive care units.

Introduction: Percutaneous tracheostomy (PT) has gained increasing acceptance over surgical tracheostomy (ST) in the last few decades due to lower rates of postoperative infections, less bleeding, and cost-effectiveness. However, there has been little information regarding the PT practice in Malaysian adult general intensive care units (ICU). The objective of the study was to assess the current practice of PT in Malaysia.

Materials and methods: This observational cross-sectional study used a validated questionnaire with 15 items. A total of 61 ICUs consisting of adult general ICUs under Ministry of Health (MOH) hospitals and adult general ICUs in university teaching hospitals were recruited into the study whereas ICUs in private hospitals and specialist ICUs were excluded from this study. The questionnaire was subsequently distributed to the heads of those 61 ICUs through existing WhatsApp or Telegram groups and the data collection period lasted four months.

Results: Fifty-three out of 61 ICUs participated. Ninety point six percent of the responses came from MOH hospitals, whereas 9.4% came from university hospitals. The heads in participating ICUs comprised 35.8% intensivists and 64.2% anaesthetists. At the time of the survey, 45.3% of ICUs were still practicing PT, 13.2% had performed PTs in the past but stopped whereas 41.5% were not. The rate of PT (both actively practising and formerly practised combined) in intensivist-led ICUs was 94.7% compared to 38.2% in anaesthetist-led ICUs. Intensivists performed PTs in almost two-thirds of ICUs, while anaesthetists did so in another two-thirds. The vast majority of assistants were medical officers at 96.8%. The Ciaglia Blue Rhino technique was the predominant technique (71.0%) while airway management during the technique was solely via endotracheal tube. Ninety-six point eight percent of the ICUs employed routine infiltration of local anaesthetics prior to PT. Thirty-eight point seven percent of performers of PT routinely used fibreoptic bronchoscopy but only 6.4% used ultrasonography. Seventy-four point two percent used tracheostomy tubes with inner cannulae and 83.9% routinely followed up with patients post-discharge from the ICU. Seventy-nine point two percent of respondents believed PT was the method of choice for elective tracheostomy in the ICU but only 49.1% perceived PT to be safer compared to ST.

Conclusion: PT is commonly practised in intensivist-led ICUs. PT is generally preferred for elective tracheostomy but there is a variability in perceptions regarding its safety compared to ST.