Comparison of Complications in Percutaneous Dilatational Tracheostomy versus Surgical Tracheostomy

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Abstract

Background:

Tracheostomy facilitates respiratory care and the process of weaning from mechanical ventilatory support.

Aims:

To compare the complications found in percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) techniques.

Methods:

This was a prospective randomized study to evaluate the complications of PDT and ST procedures in patients admitted to ICU unit of a teaching hospital during 2008 to 2011.

We studied 40 patients in each group. PDTs were performed with blue rhino technique at the bedside by a skilled clinician and all cases of STs performed by Charles G Durbin technique in operating room under general anesthesia. Bronchoscopic examination through tracheostomy tube was performed to ensure the correct position of tracheostomy tube in the trachea lumen. The duration of procedures and pre- and post-interventional complications were recorded.

Results:

The most common complications observed in the PDT group were minor bleeding (n=4), hypoxemia, and cardiac dysrhythmias (n=3) whereas in the ST group, the most frequent complications were minor bleeding (n=5) and endotracheal tube puncture (n=3). The difference in overall complications between the two groups was insignificant (P=0.12).

Conclusion:

PDT with blue rhino technique is a safe, quick, and effective method while the overall complications in both groups were comparable.

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Most cited references 21

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Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial.

Duncan Young, David A. Harrison, Brian H Cuthbertson … (2013)

Tracheostomy is a widely used intervention in adult critical care units. There is little evidence to guide clinicians regarding the optimal timing for this procedure. To test whether early vs late tracheostomy would be associated with lower mortality in adult patients requiring mechanical ventilation in critical care units. An open multicentered randomized clinical trial conducted between 2004 and 2011 involving 70 adult general and 2 cardiothoracic critical care units in 13 university and 59 nonuniversity hospitals in the United Kingdom. Of 1032 eligible patients, 909 adult patients breathing with the aid of mechanical ventilation for less than 4 days and identified by the treating physician as likely to require at least 7 more days of mechanical ventilation. Patients were randomized 1:1 to early tracheostomy (within 4 days) or late tracheostomy (after 10 days if still indicated). The primary outcome measure was 30-day mortality and the analysis was by intention to treat. Of the 455 patients assigned to early tracheostomy, 91.9% (95% CI, 89.0%-94.1%) received a tracheostomy and of 454 assigned to late tracheostomy, 44.9% (95% CI, 40.4%-49.5%) received a tracheostomy. All-cause mortality 30 days after randomization was 30.8% (95% CI, 26.7%-35.2%) in the early and 31.5% (95% CI, 27.3%-35.9%) in the late group (absolute risk reduction for early vs late, 0.7%; 95% CI, -5.4% to 6.7%). Two-year mortality was 51.0% (95% CI, 46.4%-55.6%) in the early and 53.7% (95% CI, 49.1%-58.3%) in the late group (P = .74). Median critical care unit length of stay in survivors was 13.0 days in the early and 13.1 days in the late group (P = .74). Tracheostomy-related complications were reported for 6.3% (95% CI, 4.6%-8.5%) of patients (5.5% in the early group, 7.8% in the late group). For patients breathing with the aid of mechanical ventilation treated in adult critical care units in the United Kingdom, tracheostomy within 4 days of critical care admission was not associated with an improvement in 30-day mortality or other important secondary outcomes. The ability of clinicians to predict which patients required extended ventilatory support was limited. isrctn.org Identifier: ISRCTN28588190.

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Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report.

P Ciaglia, R. Firsching, C Syniec (1985)

The development by the senior author (P.C.) of percutaneous tracheostomy from cricothyroidostomy and subcricoid fingertip tracheostomy is traced, and the technique and patient material of percutaneous subcricoid tracheostomy is presented. This new technique consists of inserting a tracheostomy tube by the use of a J guide wire inserted through a cannula into the tracheal lumen. Tapered dilators follow the guide wire and dilate the opening in the tracheal walls. A tracheostomy tube snugly fitted over a dilator is then passed into the trachea between the cricoid cartilage and the first tracheal ring. This procedure avoids the immediate and postoperative complications of "standard" tracheostomy. An experience of 134 tracheostomies of various types culminated in the development of the percutaneous technique. To date 26 such operations on 24 patients have been done with no significant complications due to the operation. The percutaneous technique should reduce the severity and incidence of intraoperative complications. Late complications, which have been no problem to date, are being evaluated with longer follow-up and with a greater patient population.

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A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients.

Jonathan Freeman, M Buchman, N. Lin … (2000)

Tracheostomy is one of the most commonly performed procedures in the patient receiving long-term mechanical ventilation. While percutaneous dilational tracheostomy (PDT) is becoming increasingly utilized as an alternative to conventional surgical tracheostomy, most literature evaluating these two techniques is neither prospective nor controlled. We performed a meta-analysis of available prospective controlled studies comparing PDT and surgical tracheostomy in critically ill patients to more fully understand the relative benefits and risks of these two procedures in this population. Meta-analysis using Mantel-Haenszel fixed effect model. We performed searches of MEDLINE, Current Contents, Best Evidence, Cochrane, and HealthSTAR databases from 1985 to present to identify prospective controlled studies comparing PDT and surgical tracheostomy in critically ill patients. After establishing clinical and statistical homogeneity (Q: statistic), studies were analyzed by a Mantel-Haenszel fixed effect model. For each clinical end point examined, PDT and surgical tracheostomy were compared by calculating either absolute differences or odds ratios (ORs) with 95% confidence intervals (CIs) for continuous or discrete variables, respectively. We pooled data from five studies (236 patients) satisfying our search criteria to analyze eight clinical end points. Operative time was shorter for PDT than surgical tracheostomy: absolute difference with 95% CI, 9. 84 min (7.83 to 10.85 min). There was no difference comparing PDT and surgical tracheostomy with respect to overall operative complication rates: OR with 95% CI, 0.732 (0.05 to 9.37). However, relative to surgical tracheostomy, PDT was associated with less perioperative bleeding (OR with 95% CI, 0.14 [0.02 to 0.39]), a lower overall postoperative complication rate (OR with 95% CI, 0.14 [0.07 to 0.29]), as well as a lower postoperative incidence of bleeding (OR with 95% CI, 0.39 [0.17 to 0.88]), and stomal infection (OR with 95% CI, 0.02 [0.01 to 0.07]). No difference was identified in days intubated prior to tracheostomy (absolute difference with 95% CI, 0.16 days [- 0.9 to 1.22 days]), overall procedure-related complications (OR with 95% CI, 0.73 [0.06 to 9.37]), or death (OR with 95% CI, 0.63 [0.18 to 2.20]) comparing these two techniques. Despite its popularity, there are currently only a limited number of small studies prospectively evaluating PDT and surgical tracheostomy. Our meta-analysis of these studies suggests potential advantages of PDT relative to surgical tracheostomy, including ease of performance, and lower incidence of peristomal bleeding and postoperative infection. If confirmed by additional, adequately powered prospective trials, these findings support PDT as the procedure of choice for the establishment of elective tracheostomy in the appropriately selected critically ill patient.

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Author and article information

Journal

Journal ID (nlm-ta): Glob J Health Sci

Journal ID (iso-abbrev): Glob J Health Sci

Title: Global Journal of Health Science

Publisher: Canadian Center of Science and Education (Canada )

ISSN (Print): 1916-9736

ISSN (Electronic): 1916-9744

Publication date (Print): July 2014

Publication date (Electronic): 20 April 2014

Volume: 6

Issue: 4

Pages: 221-225

Affiliations

[1 ]Department of Anesthesiology, Qazvin University of Medical Sciences, Qazvin, Iran

[2 ]School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran

Author notes

Correspondence: Marzieh Beigom Khezri, Associate Professor of Qazvin Medical University Science, Department of Anesthesiology, Faculty of Medicine, Shahid Bahonar, Ave 3419759811, PO Box 34197/59811, Qazvin, Iran. Tel: 98-912-381-1009. Fax: 98-281-223-6378. E-mail: mkhezri@ 123456qums.ac.ir

Article

Publisher ID: GJHS-6-221

DOI: 10.5539/gjhs.v6n4p221

PMC ID: 4825366

PubMed ID: 24999127

SO-VID: 39f9e4d4-4f2d-4d11-a6d8-7aeb11ec151f

License:

This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/3.0/).

Comparison of Complications in Percutaneous Dilatational Tracheostomy versus Surgical Tracheostomy

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Abstract

Background:

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Methods:

Results:

Conclusion:

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Most cited references 21

Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial.

Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report.

A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients.

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