title: Percutaneous versus surgical tracheostomy: A randomized controlled study with long-term follow-up.
abstract: 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.
authors.affiliation: Austin Hospital, Melbourne, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Silvester
authors.forename: Donna
authors.initials: D
authors.lastname: Goldsmith
authors.forename: Shige
authors.initials: S
authors.lastname: Uchino
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: Simon
authors.initials: S
authors.lastname: Knight
authors.forename: Siven
authors.initials: S
authors.lastname: Seevanayagam
authors.forename: Danny
authors.initials: D
authors.lastname: Brazzale
authors.forename: Marcus
authors.initials: M
authors.lastname: McMahon
authors.forename: Jon
authors.initials: J
authors.lastname: Buckmaster
authors.forename: Graeme K
authors.initials: GK
authors.lastname: Hart
authors.forename: Helen
authors.initials: H
authors.lastname: Opdam
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Pierce
authors.forename: Geoff A
authors.initials: GA
authors.lastname: Gutteridge
mesh_terms: 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*