Comparative study between percutaneous dilatationtracheostomy and surgical tracheostomy

IntroductionTracheostomy is one of the most common procedures performed in the ICU. Tracheostomy decreases the dead space and the effort of breathing, and facilitates suction and chest drainage. The easy placement of the tracheostomy tube makes it the only acceptable method for home ventilation.Tracheostomy can be performed either through percutaneous dilatation using the Seldinger technique in the ICU or surgically by an ENT surgeon in the operating room (OR). The approach for tracheostomy, whether percutaneous or surgical, remains a point of debate.AimThis an observational (prospective cohort) study to compare percutaneous dilatation tracheostomy (PDT) with surgical tracheostomy (ST) with regard to both perioperative and late postoperative complications.Patients and methodsA total of 200 patients admitted to King Abdulaziz Specialist Hospital between February 2010 and December 2013 were allocated to two groups: group A included 100 patients who had undergone PDT, and group B included 100 patients who had undergone ST. Both perioperative and late postoperative complications were recorded and compared between the two groups. Changes in blood gases, atelectasis, emphysema, pneumothorax, failure to cannulate the trachea or false passage, tracheal ring fractures, wrong site, and tracheal wall injury were considered perioperative complications, whereas bleeding, infection, stenosis, and tracheoarterial and tracheoesophageal fistula were considered late postoperative complications. ResultsPDT resulted in a significantly higher perioperative complication rate as regards blood gaschanges, false passage, and tracheal wall injury, but there was no significant difference with regard to atelectasis, tracheal ring fractures, wrong site, emphysema, and pneumothorax. However, PDT resulted in a significantly lower postoperative complication rate as regards bleeding and infection, but no statistically significant difference was found in the incidence of stenosis.Tracheoarterial and tracheoesophageal fistula were not reported in either PDT or ST.ConclusionPDT is a safe and reliable method for tracheostomy in all ICU cases and is associated with lower incidence of postoperative complications in terms of bleeding and stomal infection.