title: Early and late outcome after single step dilatational tracheostomy versus the guide wire dilating forceps technique: a prospective randomized clinical trial.
abstract: OBJECTIVE
  Percutaneous tracheostomy is frequently performed in long-term ventilated patients in the intensive care unit (ICU). Unfortunately, despite many years of experience, the optimal technique is still unknown, especially considering the occurrence of late complications. The purpose of this study was to determine which of the two most frequently used percutaneous tracheostomy techniques performs best with the emphasis on late complications.
  
  
  METHODS
  This prospective randomized trial involved 120 patients, comparing two techniques of percutaneous tracheostomy, the guide wire dilating forceps (GWDF) and the single step dilatational tracheostomy (SSDT) technique.
  
  
  RESULTS
  Sixty patients in each group underwent a percutaneous tracheostomy and were followed for up to 3 months after decannulation. The majority of complications in both groups were minor (58.3% in the GWDF group and 61.7% in the SSDT group). We found a trend towards more major perioperative complications in the GWDF group versus the SSDT group, 10.0 versus 1.7% (p = 0.06). One patient in the SSDT group developed a significant tracheal stenosis. However, this may also have been related to prolonged translaryngeal intubation. Results of magnetic resonance imaging (MRI) investigations showed only minor tracheal changes. Only 37.5% of patients in the GWDF group and 31.8% in the SSDT group had no complaints after their percutaneous tracheostomy.
  
  
  CONCLUSIONS
  Compared with the GWDF, the SSDT shows a trend toward less major perioperative complications with a comparable long-term outcome.
authors.affiliation: Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9600, 6500 HB, Nijmegen, The Netherlands. b.fikkers@ic.umcn.nl
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Fikkers
authors.forename: Marieke
authors.initials: M
authors.lastname: Staatsen
authors.forename: Frank J A
authors.initials: FJ
authors.lastname: van den Hoogen
authors.forename: Johannes G
authors.initials: JG
authors.lastname: van der Hoeven
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D004106:Dilatation / Q000379:methods; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D014139:Tracheostomy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome