Tag Archives: airway management

Percutaneous tracheostomy in Costa Rican intensive care units: Multicenter epidemiology, practices, and immediate complications

Pablo Alvarez-Aguilar1, Leonardo Chacón-Prado2, Dennis Rojas-Quirós2, Oscar Palma-Rodríguez1, Donato Salas-Segura2, TRAQUEOSCR Group

1 Hospital México, Caja Costarricense de Seguro Social, San José, Costa Rica
2 Hospital Rafaél Ángel Calderón Guardia, Caja Costarricense de Seguro Social, San José, Costa Rica

DOI: 10.2478/jccm-2026-0020

Introduction: This study describes the epidemiological and clinical profile of ICU patients undergoing percutaneous tracheostomy in Costa Rica and identifies predictors of acute complications, addressing ongoing debates on timing, technique, and risk stratification.
Methods: We performed a prospective multicenter cohort study in eight CCSS hospitals (2019–2022), including adult ICU patients undergoing percutaneous tracheostomy. Demographic, clinical, and procedural data were collected, and multivariable logistic regression identified predictors of complications.
Results: A total of 516 patients were analyzed (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%). The Ciaglia and Griggs techniques were used in 51.0% and 48.3% of cases, respectively. Capnography was applied in 74.2%, ultrasound in 17.7%, and bronchoscopy in 3.1%. First-pass success was achieved in 85.1%. Acute complications occurred in 28.3% of patients, predominantly minor bleeding (25.4%), while serious complications (airway loss, false passage, or bleeding requiring surgery) were rare (3.9%). No procedure-related deaths were observed. Independent predictors of complications included anticoagulation (OR 2.82), obesity (OR 2.10), coagulopathy (OR 2.29), prior neck surgery (OR 3.49), cervical immobilization (OR 4.68), and technical difficulty (OR 4.15 for any complication; OR 2.00 for serious complications). Airway management by physicians, compared with respiratory therapists, was also associated with higher risk (OR 1.52).
Conclusions: Percutaneous tracheostomy was feasible in multiple ICUs of the CCSS with complication rates comparable to international cohorts. Risk factors for complications included anticoagulation and prior neck surgery. Wider adoption of adjunctive monitoring tools and structured multidisciplinary training may further enhance procedural safety. These findings should be interpreted in the context of an observational design and a broad definition of complications.

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Angioedema: Is ICU admission warranted? A single institution assessment

Madeleine Brill-Edwards1, W. Chase Hamilton2, Erika J. Yoo3, Jennifer Costello4, George J. Koenig Jr.4, Murray J. Cohen4, Joshua A. Marks4

1 Eastern Virginia Medical School, Norfolk, VA, USA
2 Department of Anesthesia, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA USA; Bethlehem Campus, St. Luke’s University Health Network, Fountain Hill, PA, USA
3 Division of Pulmonary, Allergy and Critical Care Medicine, Jefferson-National Jewish Health Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
4 Division of Acute Care Surgery, Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA USA

DOI: 10.2478/jccm-2025-0023

Introduction: Angioedema has potential for rapid airway decompensation requiring intervention. Patients are often admitted to an ICU for “airway watch.” There is a lack of evidence to support which patients require this.
Aim: We aimed to characterize admission patterns and outcomes of angioedema patients at our institution to assess resource utilization and necessity of ICU use. We hypothesized that patients not requiring intubation upon presentation are safe to manage outside the ICU.
Materials and Methods: Retrospective chart review of patients admitted to our urban academic quaternary referral institution with angioedema ICD-10 codes between 2017 and 2020. Charts reviewed for demographics, etiology, admission location, level of care, length of stay (LOS), intubation information, discharge destination, and specific treatment administered. Statistical analysis included a t-test for continuous variables (LOS).
Results: Of 135 encounters for angioedema, 117 patients were admitted. 50 were admitted to an ICU. Patients were evenly split based on sex, majority black, and the most common etiology was ACE-inhibitor use. 20 required airway intervention with intubations primarily outside the ICU setting and only 2 in the ICU. 1 surgical airway performed in the ED. The mean time from presentation to intubation was 2.7 hours (Min 0h; Max 7.5h). The average ICU LOS for non-intubated patients was 1.1 days, with hospital LOS 1.5 days compared to 0.25 days for those not admitted to an ICU (p<0.001). For intubated patients, average ICU LOS was 4.3 days, with hospital LOS 6.2 days. All intubated patients were successfully liberated from the ventilator. No deaths occurred.
Conclusion: Most angioedema encounters did not require airway intervention within the first hours of presentation. Airway decompensation and intervention mostly occurred prior to the ICU setting. ICU resources should be carefully allocated and may be unnecessary for patients presenting with angioedema who are not intubated on initial evaluation.

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