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Abstract
Objective: To compare between the operative & postoperative complications, of percutaneous dilatational tracheostomy and conventional surgical tracheostomy
Design: : Prospective, randomized clinical trial study that was conducted in Suez Canal University Hospital.
Patients: patients admitted in the intensive care unit (ICU) at the Suez Canal university hospital, Ismailia, Egypt, who required a tracheostomy were included for the study.
Interventions: Tracheostomy by either percutaneous tracheostomy or surgical tracheostomy performed in the intensive care unit.
Measurements and Main Results: The primary outcome measure was the aggregate incidence of predefined moderate or severe complications. The secondary outcome measures were the incidence of each of the components of the primary outcome. Follow-up with clinical assessment. Both groups were well matched for age, gender, admission Acute Physiology and Chronic Health Evaluation II score, period of endotracheal intubation, reason for intubation, and admission diagnosis. There was no statistical difference between groups for the primary outcome. Bleeding requiring surgical intervention occurred in three percutaneous tracheostomy patients and in no surgical tracheostomy patient (p = .2). Postoperative infection (p = .044) and cosmetic sequelae (p = .08) were more common in surgical tracheostomy patients. There was a shorter delay from randomization to percutaneous tracheostomy vs. surgical tracheostomy (p = .006). Long-term follow-up revealed no complications in either group.
Conclusions: In the study undertaken we found that PTs and STs are both safe when conducted by experienced, skilled practitioners, with no difference in complications being discernable. There is less delay in performing the PT, which has better cosmetic sequelae. Neither technique should be treated lightly; both require training, experience, and an awareness of the potential risks of any medical procedure.
PT reduce the risks of transporting the patient to the operating theater, can be done in the ICU , but it cant be done on patients with obvious anatomical abnormalities.