Percutaneous dilation tracheostomy versus surgical tracheostomy in critically ill patients

Abstract

Objectives: This study was done to compare surgical tracheostomy and percutaneous dilation tracheostomy in respect to their early postoperative complications in critically ill patients.

Methods: At a university hospital general intensive care unit, we studied 109 critically ill patients who underwent either elective surgical tracheostomy (n=63) or percutaneous dilation tracheostomy (n=46). The number and type of complications during operation and early postoperative period were recorded and compared.

Results: When comparing the perioperative period of surgical versus percutaneous dilation tracheostomy, we recorded 2 vs 0 complications (NS difference).Average durations of postoperative observation (time until decannulation, release or death) were 16.04 and 16.09 days in group 1 and group 2, respectively; the difference in time was insignificant. When comparing the surgical versus percutaneous groups we have found no significant difference in postoperative complications in respect of bleeding and leakage through the space between the cannula and the stoma (bleeding 2 (3.2 %) vs 3 (6.5 %), NS; leakage 6 (9.5 %) vs 4 (8.7 %), NS). A significant difference was found in infectious complications and disintegration of tracheostomy (inflammation 17 (27 %) vs 0 (0 %), p<0.001, disintegration 14 (22.2 %) vs 0 (0), p<0.001, total number of complications 39 (61.9 %) vs 7 (15.2 %), p<0.001). No other complications were recorded.

Conclusion: Percutaneous dilation tracheostomy is an equally safe method compared with surgical tracheostomy. While posing the same perioperative risk, it requires neither the transport to the operating theater, nor the presence of the whole surgical team. In the early postoperative period, it significantly reduces the complications, mainly infections in a critically ill patient. The latter benefits make it a method of choice in elective tracheostomies at ICU (Tab. 2, Ref. 11).