A comparative study of complications and long term outcomes of Surgical Tracheostomy and two techniques of Percutaneous Tracheostomy.
BACKGROUND
The operative technique for surgical tracheostomy has remained unchanged, but different techniques for percutaneous tracheostomy have evolved due to interest in minimally invasive procedures for the critically ill patient.


OBJECTIVE
To compare the periprocedural complications and long term outcomes of bedside surgical tracheostomy (ST) with two percutaneous tracheostomy (PCT) techniques, namely serial guide wire dilating forceps (GWDF) and PercuTwist (PT).


METHODS
This prospective observational study was carried out in ICU of a tertiary referral centre over three year period on adult intubated patients needing elective tracheostomy.


METHODS
Patients with anticipated difficult neck anatomy were assigned for ST based on discretion of intensivist. Patients included for PCT were randomly assigned to the GWDT and PT technique. 90 patients underwent either bedside ST (n = 30), PCT by GWDF technique (n = 30) or PCT with PercuTwist (n = 30) and were followed up with fibreoptic bronchoscopy monthly for 06 months.


METHODS
Data was analyzed by applying chi square tests for categorical variables.


RESULTS
Periprocedural complications during PCT included major bleeding (>100ml) in two patients in GWDF group which required conversion to ST. Periprocedural bleeding was also the main complication in ST. Increased incidence of granulation tissue and tracheal narrowing in long term was seen in both ST and PCT groups. All of the P values analysed for the intra operative, post operative complications or long term outcomes were >0.05.


CONCLUSIONS
There was no statistically significant difference in incidence of complications of ST and two techniques of PCT. Proper case selection makes PCT as safe as ST.
Department of Anaesthesiology and Critical Care, Command Hospital (EC), Alipore, Kolkata - 700 027, India.
S
S
Kiran
Department of Anaesthesiology and Critical Care, Command Hospital (EC), Alipore, Kolkata - 700 027, India.
S
S
Eapen
Department of Anaesthesiology and Critical Care, Command Hospital (EC), Alipore, Kolkata - 700 027, India.
Vivek
V
Chopra
Guidewire dilating forceps; percutaneous tracheostomy complications; percutwist; surgical tracheostomy complications