Bedside Hybrid Tracheostomy Without Routine Adjunctive Guidance: A Three-Year Single-Center Experience

Background Hybrid tracheostomy (HT) combines limited surgical exposure of the anterior trachea with guidewire-based Seldinger dilation. This approach may facilitate bedside tracheostomy while reducing reliance on adjunctive guidance such as bronchoscopy. This study evaluated the procedural feasibility and short-term safety outcomes of HT in critically ill patients. Methods We retrospectively reviewed 173 consecutive adult patients who underwent bedside HT in the intensive care unit at a single center between November 2019 and March 2023. All procedures were performed by a single thoracic surgeon using a standardized technique. Procedural characteristics, procedure duration, bronchoscopy use, and procedure-related complications were assessed. Results The mean age was 67.8 years, and 65.9% of patients were male. Prolonged mechanical ventilation was the indication for tracheostomy in 96.0% of patients. The mean procedure duration was 14.25 ± 7.09 minutes, with a median of 13 minutes (interquartile range, 10–20 minutes). Bronchoscopy was used in 10 procedures early in the series and was not routinely used thereafter. No pneumothorax, subcutaneous emphysema, paratracheal tube placement, stomal infection, or tracheoesophageal fistula occurred. Major bleeding requiring surgical hemostasis occurred in two patients (1.2%), and there were no procedure-related deaths. Conclusions In this single-center retrospective series, bedside HT was feasible and was associated with a low rate of major short-term complications. After limited use early in the series, the procedure was performed without routine bronchoscopic guidance. HT may represent a practical additional option for bedside tracheostomy; however, comparative safety, resource utilization, and long-term outcomes require further evaluation.