Parma tracheostomy technique: a hybrid approach to tracheostomy between classical surgical and percutaneous tracheostomies

Abstract

Background: The aim of our study is to compare the classical surgical tracheostomy (TT) technique with a modified surgical technique designed and created by the cardiothoracic surgery staff of our department to reduce surgical trauma and postoperative complications. This modified technique combines features of percutaneous TT and surgical TT avoiding the use of specialized tools, which are required in percutaneous TT.

Methods: From October 2008 to March 2014 we performed 67 tracheostomies using this New Modified Surgical Technique (NMST) and 56 TT with the Classical Surgical Technique (CST). We collected data about the early clinical complications, deaths TT-related, deaths due to other complications and the presence of late TT's complications were performed by a telephone follow-up. SPSS software (IMB version 21) was used for the statistical analysis. Categorical data were treated with chi-square test and continuous data were treated with t-test for independent samples.

Results: NMST group had a significant lower number of early complications (P=0.005) compared to CST group (5 vs. 15). In-hospital mortality was significantly higher in CST group (18 deaths vs. 4 in NMST group, P=0.001) but we registered only one case of TT-related mortality in CST group (P=0.280). We did not note other differences between the two groups regarding short or mid-long term complications.

Conclusions: In our experience the NMST demonstrated to be easily safe and reproducible with an amount of early, mid- and long-term complications similar to the CST; furthermore the aesthetic results of the procedure appear similar to those of percutaneous TT.

Keywords: Tracheostomy (TT); cardiac surgery; intensive care unit; new technique; respiratory failure.

Figure 1

Patient positioning with hyperextension of the head and neck. A cushion is placed horizontally below the shoulders to assure the correct position (A).

Figure 2

Markers drawn with a dermographic pen before surgery. T = thyroid cartilage; C = cricoid ring; I = incision; J = jugular fossa. Note the length of the incision.

Figure 3

Isolation of the trachea and management of thyroid isthmus. (A) View of the operative field (anaesthesiologist’s side); (B) management of thyroid isthmus that is retracted upward (anaesthesiologist’s side).

Figure 4

Diagram of the insertion of the cannula. (A) Inserting the cannula armed with the silicone probe beak flute shaped. The black arrow shows the retraction of the probe once the cannula is positioned; (B) operative view before the positioning.