[Percutaneous or surgical trachetomy. Prospective, randomized comparison of the incidence of early and late complications].
BACKGROUND
To compare early and late complications after either conventional surgical or percutaneous dilatational tracheostomy.


METHODS
Prospective, randomized study.


METHODS
General intensive care unit and neuro-surgical intensive care unit in a university hospital.


METHODS
50 consecutive patients, requiring tracheostomy for prolonged mechanical ventilation.


METHODS
Patients were randomly allocated to receive either surgical (surgical group, n = 25) or percutaneous dilatational tracheostomy (percutaneous group, n = 25). Occurrence of perioperative complication were carefully evaluated during ICU stay. Late complications were evaluated with both physical and endoscopic examination at 1, 3 to 6 months after tracheostomy.


RESULTS
All surgical and percutaneous tracheostomies were successfully completed and no deaths directly related to the tracheostomy procedures were reported. Completion of the procedure required 41 +/- 14 min in the surgical group and 14 +/- 6 min in the percutaneous one (p < 0.0001). The incidence of early perioperative complications was higher in the surgical group (36%) than in percutaneous one (12%), (p < 0.05). The endoscopic follow-up demonstrated one segmental malacia and one stenosis of the trachea in the percutaneous group only (p = n.s.). Skin repair was better after percutaneous tracheostomy than in the surgical group (p < 0.01).


CONCLUSIONS
In experienced hands, percutaneous dilatational tracheostomy is as safe and effective as the conventional surgical tracheostomy. The percutaneous technique is less time-consuming and has a lower rate of early infectious complications with better cosmetic results than the surgical technique.
Muttini
S
S
Servizio di Anestesia e Rianimazione, IRCCS H San Raffaele, Università degli Studi, Milano.
Melloni
G
G
Gemma
M
M
Casati
A
A
Carretta
A
A
Giudici
D
D
Cozzi
S
S
Chiesa
G
G
Gallioli
G
G
Beretta
L
L
Casaletti
E
E
Torri
G
G
D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial; D013997:Time Factors; D014140:Tracheotomy / Q000009:adverse effects* / Q000379:methods