Performance, Long-term anagement, and Coding for Percutaneous Dilational Tracheostomy

Percutaneous dilatational tracheotomy (PDT) has become increasingly popular and has gained widespread acceptance. The modern PDT procedure has also evolved to whereby it can be safely performed by surgeons and nonsurgeons in the ICU. Moreover, bedside PDT has proven clinical outcomes and can save hospital resources. As such, PDT done in the ICU is now a widely performed procedure, often being the tracheostomy procedure of choice. Today, many pulmonologists and intensivists who can use bedside PDT do not perform this procedure; it is conceivable this practice may expand, especially among pulmonologists and intensivists. Although numerous indications exist for tracheostomy, the focus of this article is limited to bedside PDT for prolonged mechanical ventilation, which is the most common indication for this procedure. We describe the logistics and operations needed for programs to incorporate PDT into routine ICU care.