Early Percutaneous Tracheostomy in a Patient with Hemorrhagic Stroke and Ventilatory Failure

Background: Hemorrhagic stroke, particularly subarachnoid and intraventricular hemorrhage (SAH and IVH), is associated with high morbidity, reduced consciousness, and prolonged mechanical ventilation. Prolonged intubation increases the risk of ventilator-associated pneumonia (VAP) and delays recovery. Percutaneous dilatational tracheostomy (PDT) is a minimally invasive procedure that enables safer weaning, better airway hygiene, and earlier rehabilitation. Case Presentation: We report a case of a 67-year-old woman presenting with sudden decreased consciousness. Brain CT revealed extensive SAH and IVH, Fisher grade 4. She was intubated and admitted to the ICU for ventilation and neurocritical care. On day 4, sputum culture revealed Acinetobacter baumannii, and antibiotics were tailored accordingly. Due to persistent low GCS and secretion retention, PDT was performed on day 7. The PDT was conducted at the bedside using the Ciaglia Blue Rhino technique under bronchoscopic guidance. Adequate sedation, local anesthesia, and full aseptic technique were employed. The tracheostomy tube was placed between the second and third tracheal rings without complications. Following the procedure, the patient showed improved respiratory hygiene and tolerance to spontaneous breathing. She was successfully weaned off the ventilator and transferred to high-dependency care on day 13. Conclusion: This case highlights the effectiveness of early PDT in patients with hemorrhagic stroke requiring prolonged ventilation. When combined with culture-guided antibiotics and multidisciplinary ICU care, PDT can enhance outcomes and facilitate safer recovery.