Percutaneous dilatational versus conventional surgical tracheostomy in intensive care patients

Abstract

Background:Tracheostomy is usually performed in patients with difficult weaning from mechanical ventilation or some catastrophic neurologic insult. Conventional tracheostomy involves dissection of the pretracheal tissues and insertion of the tracheostomy tube into the trachea under direct vision. Percutaneous dilatational tracheostomy is increasingly popular and has gained widespread acceptance in many intensive care unit and trauma centers.Aim:Aim of the study was to compare percutaneous dilatational tracheostomy versus conventional tracheostomy in intensive care patients.Patients and Methods:64 critically ill patients admitted to intensive care unit subjected to tracheostomy and randomly divided into two groups; percutaneous dilatational tracheostomy and conventional tracheostomy.Results:Mean duration of the procedure was similar between the two procedures while the mean size of tracheostomy tube was smaller in percutaneous technique. In addition, the Lowest SpO2 during procedure, PaCO2 after operation and intra-operative bleeding for both groups were nearly similar without any statistically difference. Postoperative infection after 7 days seen to be statistically lowered and the length of scar tend to be smaller among PDT patients.Conclusion:PDT technique is effective and safe as CST with low incidence of post operative complication.

Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations

“…The 53 The other minor complications like cosmetic sequelae and postoperative infections have been higher with ST (p = 0.044). 54 The skin incision size was smaller with PDT (p < 0.0001). 55 The meta-analysis by Higgins et al 56 which included 15 studies (N = 973), 55,[57][58][59][60][61][62][63][64][65][66][67][68][69][70] showed no statistical significance for major complications between ST and PDT but the overall pattern of complications favored PDT (0.75, 0.56-1.00, p = 0.05) in regards to incision scarring, wound infection and shortened procedure time.…”

Utility of Percutaneous Dilatational Tracheostomy in the Immediate Postoperative Period of Liver Transplant

“…18 Probably for all these reasons, it has become, in many cases, the technique of choice when performing a tracheostomy in critically ill patients. [19][20][21][22] The practice of PDT in the immediate postoperative period of OLT patients appears to be a safe technique, comparable to that performed on other patients. This statement must be weighed against the fact that evidence of major bleeding, in our series, was more frequent in OLT patients.…”

Comparison of the effects of different percutaneous tracheotomy techniques on acute tracheal trauma

“…There are increasing numbers of studies in the literature that report the benefits of percutaneous techniques over traditional methods, such as decreased complication rates, thereby making percutaneous techniques a popular option (9)(10)(11) Data are presented as median (min-max) for difficulty score and mean ± SD for other parameters. *: P<0.05 for Group I vs. Groups II, III, and IV.…”