Percutaneous versus surgical tracheostomy: A randomized controlled study with long-term follow-up.
OBJECTIVE
To compare the safety, availability, and long-term sequelae of percutaneous vs. surgical tracheostomy.


METHODS
Prospective, randomized, controlled study.


METHODS
Combined medical/surgical intensive care unit in a tertiary referral hospital.


METHODS
Two hundred critically ill mechanically ventilated patients who required tracheostomy.


METHODS
Tracheostomy by either percutaneous tracheostomy or surgical tracheostomy performed in the intensive care unit.


RESULTS
The primary outcome measure was the aggregate incidence of predefined moderate or severe complications. The secondary outcome measures were the incidence of each of the components of the primary outcome. Long-term follow-up included clinical assessment, flow volume loops, and bronchoscopy. Both groups were well matched for age, gender, admission Acute Physiology and Chronic Health Evaluation II score, period of endotracheal intubation, reason for intubation, and admission diagnosis. There was no statistical difference between groups for the primary outcome. Bleeding requiring surgical intervention occurred in three percutaneous tracheostomy patients and in no surgical tracheostomy patient (p = .2). Postoperative infection (p = .044) and cosmetic sequelae (p = .08) were more common in surgical tracheostomy patients. There was a shorter delay from randomization to percutaneous tracheostomy vs. surgical tracheostomy (p = .006). Long-term follow-up revealed no complications in either group.


CONCLUSIONS
Both percutaneous tracheostomies and surgical tracheostomies can be safely performed at the bedside by experienced, skilled practitioners.
Silvester
William
W
Austin Hospital, Melbourne, Australia.
Goldsmith
Donna
D
Uchino
Shige
S
Bellomo
Rinaldo
R
Knight
Simon
S
Seevanayagam
Siven
S
Brazzale
Danny
D
McMahon
Marcus
M
Buckmaster
Jon
J
Hart
Graeme K
GK
Opdam
Helen
H
Pierce
Robert J
RJ
Gutteridge
Geoff A
GA
D000368:Aged; D002921:Cicatrix / Q000209:etiology; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology; D011446:Prospective Studies; D012121:Respiration, Artificial; D013530:Surgical Wound Infection / Q000209:etiology; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods*