Percutaneous versus surgical bedside tracheostomy in the intensive care unit: a cohort study.

BACKGROUND: To compare the outcomes, as well as the short and long term complications, of percutaneous dilational tracheostomy (PDT) and surgical tracheostomy (ST) at the bedside. METHODS: From 2003 to 2005, 367 consecutive patients underwent percutaneous tracheostomy in two general ICUs of a community hospital. Short and long term complications, procedural time, duration on mechanical ventilation, length of stay in the ICU and in the hospital, and mortality rates were compared to a historical cohort of 161 patients treated with surgical tracheostomy. Both groups were comparable in demographic characteristics and severity scores. RESULTS: As a whole, 528 mechanically ventilated patients underwent tracheostomy at the bedside. 161 patients received ST and 367 PDT by the single dilator technique. Only minor complications were observed in both groups of patients. PDT was performed more rapidly than ST (5.4+/-5.2 vs 19+/-10 min). STs were performed significantly later than PDT (12.4+/-6 days vs 8.7+/-5.8 days, P<0.05). The overall ICU stay and mean duration of mechanical ventilation were lower in the PDT than in the ST group (18.4+/-13.9 vs 23.3+/-15.8 days, P< 0.05 and 14.2+/-8.1 vs 20.1+/-10.4, P<0.05, respectively). There were no statistically significance differences in ICU and hospital outcome between the two techniques. CONCLUSION: Compared with ST, the main advantage of PDT is that it is more rapid and allows the tracheostomy to be performed earlier in the course of ventilatory failure. Early tracheostomy is associated with a shorter duration of mechanical ventilation and a reduced ICU length of stay.

Helicobacter pylori isolated from stomach corpus and antrum: comparison of DNA patterns.

The genomic DNA of Helicobacter pylori was studied in strains isolated from two different sites of the stomach: the corpus and the antrum. 70 strains of H. pylori were found in 36 patients; 34 out of the 36 patients harboured the strain in both districts analysed. Restriction endonuclease analysis with Hae III and Hind III was used to compare the DNA patterns of strains isolated from the anatomical sites studied. Two pairs of DNA samples were not digested by these enzymes. 27 of the 32 pairs of the digested DNA appeared similar to each other. The analysis of chromosomal DNA in the remaining five pairs showed different electrophoretic patterns. These results indicate that the gastric mucosa can be colonized, at the same time, by strains of H. pylori with different genomic patterns, and this aspect can be important for epidemiological studies.