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A comparison of percutaneous and operative tracheostomies in intensive care patients

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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.


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.


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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).

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Key words

  • equipment: tracheostomy
  • intensive care, ventilation: mechanical