Percutaneous tracheostomy versus surgical tracheostomy in ICU patients

ABSTRACT

Tracheostomy is one of the most commonly performed surgical procedures in the critically ill patient. This procedure has been performed using standard surgical principles. Percutaneous dilatational tracheostomy [PDT] was first described in 1957 5 and became increasingly popular after the release of a commercially available kit in 1985. The aim of this study is to compare percutaneous dilatational tracheostomy with surgical tracheostomy in regards to the overall mortality as well as major perioperative and postoperative complications. Fifty ICU patients indicated for tracheostomies were included in prospective randomized study. Our patients were divided into 2 equal groups; percutaneous tracheostomy and surgical tracheostomy group. The outcome measures were divided into perioperative, early postoperative and late postoperative complications. The perioperative designation was used to categorize complications that occur between initiation of the procedure and 24 hours postoperatively. Early postoperative evaluation was performed daily during the first week and then on the 14th day. Long-term evaluation was done 3 months after decannulation. The total incidence of perioperative complications was 28% and 24% in the surgical and percutaneous tracheostomy group respectively. Early postoperative complications were significantly more frequent after surgical tracheostomy [52%] than after percutaneous tracheostomy [20%]. Long-term evaluation was completed in 32 patients [18 SgT and 14 PDT]. Eighteen patients died of their underlying disease. 6 patients [2 SgT and 4PDT] still needed their tracheostomy. The cumulative incidence of long-term complication was 77% and 35% in the SgT and PDT groups respectively. Percutaneous tracheostomy and surgical tracheostomy are both safe when performed by experienced skilled practitioners. However, percutaneous dilatational tracheostomy is simpler and faster technique than surgical tracheostomy