Surgical tracheostomy versus percutaneous dilatational tracheostomy. A prospective-randomized study with long-term follow-up.
BACKGROUND
To compare surgical tracheostomy (ST) versus percutaneous dilatational tracheostomy (PDT) in terms of complication rates. In particular we specifically studied the late tracheal complications of both methods by means of endoscopic controls of patients up to 6 months after the procedures.


METHODS



METHODS
prospective-randomized clinical study.


METHODS
University-affiliated tertiary care referral hospital.


METHODS
50 consecutive translaryngeally intubated patients with respiratory failure were randomized to undergo either ST (25 patients) or endoscopic guided PDT (25 patients).


RESULTS
ST was performed in 41+/-14 min versus 14+/-6 min for PDT (p<0.0001). There was no procedure-related death. In the ST group there were no intraoperative complications. In the PDT group 2 intraoperative complications (minor hemorrhages) were observed. In the ST group 9 early postoperative complications occurred: one minor bleeding, 7 stomal infections and one accidental decannulation. In the PDT group only one early postoperative complication (minor bleeding) occurred. Early postoperative complication rates were 36% for ST and 4% for PDT. In the ST group there were no late tracheal complications. In the PDT group 2 late tracheal complications (one segmental malacia and one stenosis at the level of the stoma) were observed.


CONCLUSIONS
This study confirms that PDT is a simpler and quicker procedure than ST and that it has a lower rate of early postoperative complications. Late tracheal complications were more frequent, although the difference was not statistically-significant, in the PDT group. Further investigations of long-term outcome following PDT are therefore necessary.
Melloni
G
G
Department of Thoracic Surgery, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy. melloni.giulio@hsr.it
Muttini
S
S
Gallioli
G
G
Carretta
A
A
Cozzi
S
S
Gemma
M
M
Zannini
P
P
D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000473:pathology / Q000628:therapy*; D013906:Thoracoscopy; D013997:Time Factors; D014133:Tracheal Diseases / Q000209:etiology* / Q000473:pathology; D014139:Tracheostomy / Q000009:adverse effects*