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A comparison of percutaneous and operative tracheostomies in intensive care patients

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Abstract

The aim of our study was to compare the complication rate of convenional surgical and percutaneous dilational tracheostomies performed under general anaesthesia in critically ill patients. Fifty-three consecutive patients whose lungs were mechanically ventilated and who required tracheostomy were randomised to undergo either conventional surgical tracheostomy (n = 28) in the operating room or percutaneous dilational tracheostomy (n = 25) in the intensive care unit under general anaesthesia. All of the procedures were successfully completed. No deaths were related to the performance of either tracheostomy technique. Three patients in each group required a dressing change for minor bleeding at the tracheostomy site. There was no major bleeding requiring blood transfusion. One patient in each group developed atelectasis detected on chest x-ray postoperatively. In the surgical tracheostomy group, there were two patients with cuff leaks, one with a stomal infection and one with a pneumothorax. None of these complications occurred after percutaneous, dilational tracheostomy. We conclude that the low incidence of complications in both groups indicates that percutaneous dilational tracheostomy can be performed as safely in the intensive care unit with general anaesthesia as surgical tracheostomy can be performed in the operating room.

Résumé

Nous comparons l’incidence des complications causées par la trachéotomie chirurgicale traditionnelle avec celles de la trachéotomie percutanée par dilatation réalisées sous anesthésie générate chez des grands malades. Cinquante-trois patients consécutifs sous ventilation mécanique dont l’état nécessitait une trachéotomie sous anesthésie générate sont répartis pour subir soit une trachéotomie chirurgicale traditionnelle (n = 28) en salle d’opération, soit une trachéotomie percutanée par dilatation (n = 25) a l’unité des soins intensifs. Toutes les interventions ont été complétées avec succès. Aucun décès en rapport avec une ou l’autre des méihodes n’est survenu. Dans les deux groupes, on a du changer le pansement de trois patients pour un saignement mineur du site de la trachéotomie. Il n’y a pas eu de saignement majeur nécessitant de transfusions. Dans chaque groupe, on a détecté de l’atélectasie à la radiographie postopératoire. Dans le groupe de la trachéotomie chirurgicale, deux patients ont présenté des fuites au niveau du ballonnet de la canule, un patient a présenté une infection du stoma et un autre a présenté un pneumothorax. Ces complications ne sont pas survenue avec la méthode percutanée. L’incidence faible de complications dans les deux groupes montre que la trachéotomie percutanée peut être réalisée aussi bien à l’unité des soins intensifs sous anesthésie générate que la trachéotomie chirurgicale en salle d’opération.

References

  1. 1

    Heffner JE, Miller KS, Sahn SA. Tracheostomy in the intensive care unit Part 1: Indications, technique, management. Chest 1986; 90: 269–74.

  2. 2

    Stock MC, Woodward CG, Shapiro BA, Cane FD, Lewis V, Pecaro B. Perioperative complications of elective tracheostomy in critically ill patients. Crit Care Med 1986; 14: 861–3.

  3. 3

    Stauffer JL, Olson DE, Petty TL. Complications and consequences of endotracheal intubation and tracheotomy. Am J Med 1981; 70: 65–76.

  4. 4

    Chew JY, Cantrell RW. Tracheostomy: complications and their management. Arch Otolaryngol 1972; 96: 538–45.

  5. 5

    Skaggs JA, Cogbill CL. Tracheostomy; management, mortality, complications. Am Surg 1969; 35: 393–6.

  6. 6

    Glas WW, King OJ Jr,Lui A. Complications of tracheostomy. Arch Surg 1962; 85: 72–9.

  7. 7

    Jackson C. Tracheostomy. Laryngoscope 1909; 19: 285–90.

  8. 8

    Toy FJ, Weinstein JD. A percutaneous tracheostomy device. Surgery 1969; 65: 384–9.

  9. 9

    Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy: a new simple bedside procedure; preliminary report. Chest 1985; 87: 715–9.

  10. 10

    Paul A, Marelli D, Chiu RC-J, Vestweber KH, Mulder DS. Percutaneous endoscopic tracheostomy. Ann Thorac Surg 1989; 47: 314–5.

  11. 11

    Cook PD, Callanan VI. Percutaneous dilational tracheostomy technique and experience. Anaesth Intensive Care 1989; 17: 456–7.

  12. 12

    Hazard PB, Garrett HE Jr,Adams JW, Robbins ET, Aguillard RN. Bedside percutaneous tracheostomy: experience with 55 elective procedures. Ann Thorac Surg 1988; 46: 63–7.

  13. 13

    Hazard P, Jones C, Benitone J. Comparative clinical trial of standard operative tracheostomy with percutaneous tracheostomy. Crit Care Med 1991; 19: 1018–24.

  14. 14

    Karnik R, Winkler W-B, Seelmann O, Havlicek J, Slany J. Bedside percutaneous dilatational tracheostomy with endoscopic guidance: experience in 72 ICU patients. Crit Care Med 1993; 21: S252.

  15. 15

    Barba CA, Angood PB, Kauder DR, et al. Endoscopically guided percutaneous dilatational tracheostomy: a safe, easy and cost-saving procedure. Crit Care Med 1993; 21: S251.

  16. 16

    Cooper RM, Irish JC, Brown DH. A new technique for percutaneous dilational tracheostomies using an endotracheal ventilation catheter. Can J Anaesth 1993; 40: A71.

  17. 17

    Griggs WM, Myburg JA, Worthley LIG. A prospective comparison of a percutaneous tracheostomy technique with standard surgical tracheostomy. Intensive Care Med 1991; 17: 261–3.

  18. 18

    Toye FJ, Weinstein JD. Clinical experience with percutaneous tracheostomy and cricothyroidotomy in 100 patients. J Trauma 1986; 26: 1034–40.

  19. 19

    Anderson HL III, Bartlett RH. Elective tracheotomy for mechanical ventilation by the percutaneous technique. Clin Chest Med 1991; 12: 555–60.

  20. 20

    Friedman Y, Mayer AD. Bedside percutaneous tracheostomy in critically ill patients. Chest 1993; 104: 532–5.

  21. 21

    Bodenham A, Diament R, Cohen A, Webster N. Percutaneous dilational tracheostomy. A bedside procedure on the intensive care unit. Anaesthesia 1991; 46: 570–2.

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Correspondence to Glenn P. McGuire.

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Crofts, S.L., Alzeer, A., McGuire, G.P. et al. A comparison of percutaneous and operative tracheostomies in intensive care patients. Can J Anaesth 42, 775–779 (1995). https://doi.org/10.1007/BF03011175

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Key words

  • equipment: tracheostomy
  • intensive care, ventilation: mechanical