10.7910/DVN/TH5DPCRyu, Jeong-AmJeong-AmRyuCritical care medicine, Samsung medical center, Seoul, KoreaHarvard Dataverse2019Medicine, Health and Life SciencesRyu, Jeong-AmCritical care medicine, Samsung medical center, Seoul, Korea2019-07-032020-05-2588560156035557048text/tab-separated-valuesapplication/pdftext/tab-separated-values3.0CC0 1.0Background: We evaluated severe pain-related adverse events (SAEs) during the procedure of percutaneous dilatational tracheostomy (PDT) by a neurointensivist, compared with conventional surgical tracheostomy in neurocritically ill patients. Methods: This was a retrospective and observational study of adult patients who underwent tracheostomy, admitted to the neurosurgical intensive care unit January 2014 through March 2018. In this study, primary endpoints were incidence of SAE: cardiac arrest, arrhythmias, hypertension, hypotension, desaturation, bradypnea, or ventilatory distress. Secondary endpoint was procedure-induced complications. Results: A total of 156 patients underwent tracheostomy during the study. Elective surgery of brain tumor (34.0%) and intracranial hemorrhage (20.5%) were the most common reasons for admission. The most common reasons for tracheostomy were difficult ventilator weaning or prolonged intubation (42.9%) and reduction of sedative (23.7%). Midazolam (70.3%) was most commonly used among sedatives and analgesics. Tachycardia (30.1%) and hypertension (30.1%) were most common events of SAEs. Incidences of SAEs were more common in conventional tracheostomy, compared to PDT (67.1% vs. 42.3%, P = 0.002). Total duration of SAEs (19.8 ± 23.0 min vs. 3.4 ± 5.3 min, P < 0.001) and procedural time (42.2 ± 21.8 min vs. 17.7 ± 9.2 min, P < 0.001) were lengthier in conventional tracheostomy compared to PDT. Although there was no difference in use of sedative (P = 0.237) between the two groups, analgesic (p < 0.001) was less used in conventional tracheostomy rather than PDT. Procedure-induced complications were more common in conventional tracheostomy compared to PDT (23.5% vs. 11.3%, P = 0.047). Conclusions: In PDT performed by a neurointensivist, decreased SAEs may be associated with short procedural time and adequate control of sedation and pain. Therefore, PDT by a neurointensivist may be safe and feasible in neurocritically ill patients.