title: [Percutaneous or surgical trachetomy. Prospective, randomized comparison of the incidence of early and late complications].
abstract: 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.
authors.affiliation: Servizio di Anestesia e Rianimazione, IRCCS H San Raffaele, Università degli Studi, Milano.
authors.forename: S
authors.initials: S
authors.lastname: Muttini
authors.forename: G
authors.initials: G
authors.lastname: Melloni
authors.forename: M
authors.initials: M
authors.lastname: Gemma
authors.forename: A
authors.initials: A
authors.lastname: Casati
authors.forename: A
authors.initials: A
authors.lastname: Carretta
authors.forename: D
authors.initials: D
authors.lastname: Giudici
authors.forename: S
authors.initials: S
authors.lastname: Cozzi
authors.forename: G
authors.initials: G
authors.lastname: Chiesa
authors.forename: G
authors.initials: G
authors.lastname: Gallioli
authors.forename: L
authors.initials: L
authors.lastname: Beretta
authors.forename: E
authors.initials: E
authors.lastname: Casaletti
authors.forename: G
authors.initials: G
authors.lastname: Torri
mesh_terms: 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