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Tracheostomy: Open Surgical or Percutaneous? An Effort to Solve the Continued Dilemma

  • N. Ramakrishnan
  • Jitendra Kumar SinghEmail author
  • Salil Kumar Gupta
  • Vijay Bhalla
  • D. K. Singh
  • Sheetal Raina
  • Abha Kumari
Original Article
  • 12 Downloads

Abstract

Due to lack of globally standardized guidelines and clarity on indications, patient selection, intra-operative preparations, technique, complications, postoperative care and decannulation protocols, percutaneous tracheostomy (PT) has come in vogue as compared to standard open surgical tracheostomy (OST). PercuTwist and guide wire dilatational method (GWDF), techniques of PT, offer lesser operative time and ease of surgery being a bedside procedure. There seems to be paucity of Indian literature on rising trend of increasing indications, post-operative care, management of complications and outcomes of tracheostomy. And thus, there arises a felt need to envisage a study in tertiary care setup targeting these issues and to question the so far unchallenged acceptance of new techniques and technology. Our aim is to study the recent trend of indications, complications, and outcomes of both OST and PT in a cohort of Indian patients who underwent tracheostomy. 80 patients with mean age of 59.0 ± 15 years underwent tracheostomy (OST: 48 (60%), PT: 32 (40%), and among PT, PercuTwist: 16 (50%), GWDF: 16 (50%)) for various indications with objectives to compare operative time, complications and decannulation rates of tracheostomy surgery, within the follow up period of 3 months. Most common indication of elective tracheostomy was prolonged ventilation, and for emergency ones, upper airway obstruction. Mean operative time taken by all the three techniques was comparable, i.e., 16.3 v/s 15 v/s 15.3 min (Open v/s PT GWDF v/s PT PercuTwist). Most common intra-operative complication of OST was haemorrhage (16.3%) and that of PT was false passage (8.8%). Early post-operative complications were haemorrhage (OST: 3.75%, PT: 1.25%) and tube blockage and dislodgement (equal distribution among OST and PT). Late post-operative complications were stomal granulations in PT: 7.5%. Outcomes of tracheostomy were significantly better with OST (36 (45%)) than PT (14 (17.5%)). In PT group, PercuTwist fared better than GWDF in terms of lesser complications (PercuTwist: 10%, GWDF: 18.6%) and better decannulation rates (PercuTwist: 13.6%, GWDF: 3.75%). Most common indication for tracheostomy remains prolonged intubation; complication of OST is intra and early post-operative haemorrhage and that of PT being tube dislodgement and blockage. Outcomes in form of successful decannulation are with OST.

Keywords

Emergency tracheostomy Elective tracheostomy Open surgical tracheostomy Percutaneous tracheostomy PercuTwist Guide wire dilatational method Decannulation 

Notes

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interests.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Written informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Boyd AD (1994) Chevalier Jackson: the father of American bronchoesophagoscopy. Ann Thorac Surg 57(2):502–505.  https://doi.org/10.1016/0003-4975(94)91037-5 CrossRefGoogle Scholar
  2. 2.
    Alabi B, Afolabi O, Dunmade A, Omokanye H, Ajayi I, Ayodele S, Busari N (2018) Indications and outcome of tracheostomy in Ilorin, North Central Nigeria: 10 years review. Ann Afr Med 17(1):1CrossRefGoogle Scholar
  3. 3.
    Berrouschot J, Oeken J, Steiniger L, Schneider D (1997) Perioperative complications of percutaneous dilational tracheostomy. Laryngoscope 107(11):1538–1544.  https://doi.org/10.1097/00005537-199711000-00021 CrossRefGoogle Scholar
  4. 4.
    Dulguerov P, Gysin C, Perneger TV, Chevrolet J-C (1999) Percutaneous or surgical tracheostomy: a meta-analysis. Crit Care Med 27(8):1617–1625CrossRefGoogle Scholar
  5. 5.
    Toye FJ, Weinstein JD (1986) Clinical experience with percutaneous tracheostomy and cricothyroidotomy in 100 patients. J Trauma 26(11):1034–1040CrossRefGoogle Scholar
  6. 6.
    Durbin CG (2005) Techniques for performing tracheostomy. Respir Care 50(4):488–496Google Scholar
  7. 7.
    Freeman BD, Isabella K, Lin N, Buchman TG (2000) A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest 118(5):1412–1418CrossRefGoogle Scholar
  8. 8.
    Mitchell RB, Hussey HM, Setzen G, Jacobs IN, Nussenbaum B, Dawson C, Brown CA, Brandt C, Deakins K, Hartnick C, Merati A (2013) Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg 148(1):6–20.  https://doi.org/10.1177/0194599812460376 CrossRefGoogle Scholar
  9. 9.
    Durbin CG (2005) Indications for and timing of tracheostomy. Respir Care 50(4):483–487Google Scholar
  10. 10.
    Antonelli M, Michetti V, Di Palma A, Conti G, Pennisi MA, Arcangeli A, Montini L, Bocci MG, Bello G, Almadori G (2005) Percutaneous translaryngeal versus surgical tracheostomy: a randomized trial with 1-yr double-blind follow-up. Crit Care Med 33(5):1015–1020CrossRefGoogle Scholar
  11. 11.
    Montcriol A, Bordes J, Asencio Y, Prunet B, Lacroix G, Meaudre E (2011) Bedside percutaneous tracheostomy: a prospective randomised comparison of PercuTwist® versus Griggs’ forceps dilational tracheostomy. Anaesth Intensive Care 39(2):209–216.  https://doi.org/10.1177/0310057x1103900209 CrossRefGoogle Scholar
  12. 12.
    Yurtseven N, Aydemir B, Karaca P, Aksoy T, Komurcu G, Kurt M, Ozkul V, Canik S (2007) PercuTwist: a new alternative to Griggs and Ciaglia’s techniques. Eur J Anaesthesiol 24(6):492–497CrossRefGoogle Scholar
  13. 13.
    Schiefner J, Magnusson K, Zaune U, Vester E (2004) Percutaneous dilatational tracheostomy—a comparison of three methods: Ciaglia Blue Rhino, PercuTwist and Griggs’ Guidewire Dilation Forceps (GWDF). Crit Care 8(1):P4.  https://doi.org/10.1186/cc2471 CrossRefGoogle Scholar
  14. 14.
    Choate K, Barbetti J, Currey J (2009) Tracheostomy decannulation failure rate following critical illness: a prospective descriptive study. Aust Crit Care 22(1):8–15.  https://doi.org/10.1016/j.aucc.2008.10.002 CrossRefGoogle Scholar
  15. 15.
    Stelfox HT, Crimi C, Berra L, Noto A, Schmidt U, Bigatello LM, Hess D (2008) Determinants of tracheostomy decannulation: an international survey. Crit Care 12(1):R26.  https://doi.org/10.1186/cc6802 CrossRefGoogle Scholar
  16. 16.
    Higgins KM, Punthakee X (2007) Meta-analysis comparison of open versus percutaneous tracheostomy. Laryngoscope 117(3):447–454.  https://doi.org/10.1097/01.mlg.0000251585.31778.c9 CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  1. 1.Base HospitalLucknow CanttLucknowIndia
  2. 2.Department of ENT & HNSCommand Hospital (Eastern Command)KolkataIndia

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