• Paresh C Giri, Amy Bellinghausen Stewart, Vi A Dinh, Ara A Chrissian, and H Bryant Nguyen.
• Department of Medicine, Pulmonary and Critical Care, Loma Linda University, Loma Linda, CA, USA.
• J Crit Care. 2015 Apr 1;30(2):321-6.

PurposePercutaneous dilatational tracheostomy (PDT) is increasingly becoming the preferred method, compared with open surgical tracheostomy, for patients requiring chronic ventilatory assistance. Little is known regarding the process involved to incorporate PDT as a standard service in the medical intensive care unit. In this report, we describe our experience developing a "PDT service" led by medical intensivists.Materials And MethodsWith support from our leadership and surgical colleagues, we developed a credentialing and training process for medical intensivists, formulated a bedside team to perform PDT, refined our technique, and maintained a patient data registry for quality improvement.ResultsTo date, our service includes 4 medical intensivists with PDT privileges. Over a 4-year period, we performed 171 PDTs for patients in the medical intensive care unit after 12.1 ± 8.2 days of mechanical ventilation. Our procedure-related complication rates are similar to other reports. No patient required emergent open surgical tracheostomy, and there were no deaths related to PDT. We required minimal to no backup support from our surgical colleagues in performing PDT.ConclusionsWe successfully developed a medical intensivist-driven PDT service, sharing our unique successes and challenges, to facilitate the care of our patients requiring prolonged ventilator support.Copyright © 2014 Elsevier Inc. All rights reserved.

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