Comparative study between percutaneous dilatation tracheostomy and surgical tracheostomy

الملخص EN

Introduction Tracheostomy 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.

Aim This 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 methods A 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 fi stula were considered late postoperative complications.

Results PDT resulted in a signifi cantly higher perioperative complication rate as regards blood gas changes, false passage, and tracheal wall injury, but there was no signifi cant difference with regard to atelectasis, tracheal ring fractures, wrong site, emphysema, and pneumothorax.

However, PDT resulted in a signifi cantly lower postoperative complication rate as regards bleeding and infection, but no statistically signifi cant difference was found in the incidence of stenosis.

Tracheoarterial and tracheoesophageal fi stula were not reported in either PDT or ST.

Conclusion PDT 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.