Letter to the Editor on “Percutaneous Dilational Tracheostomy without Bronchoscopy: Placement is Safe, Reintervention is Not.”

To the Editors: We read with great interest the recent report entitled “Performing Percutaneous Dilational Tracheostomy Without Using Fiberoptic Bronchoscope”. This descriptive study reviewed 70 cases of the aforementioned procedure and concluded that it was efficient and safe (1). This is supported by prior work, (2,3) noting however that this technique is frequently preempted by any suspicion of difficult airway anatomy, for prior history of airway problems and for those patients who have had a previous tracheostomy. Thus, some authors have argued that bronchoscopic guidance improves safety (4). Nonetheless, due to the expanding performance of percutaneous dilational tracheostomy without bronchoscopy, some physicians may attempt to manipulate or replace newly placed tracheostomy tubes without bronchoscopy for problems such as cuff rupture. This may pose a severe risk to patients.