Comparison of the efficacy of surgical tracheostomy and percutaneous dilatational tracheostomy with flexible lightwand and ultrasonography in geriatric intensive care patients

Abstract

Aim To compare the applicability, technical difficulties and postoperative complications of surgical tracheostomy and percutaneous dilatational tracheostomy with the flexible lightwand + ultrasonography method applied because of prolonged intubation to geriatric patients in the intensive care unit. Methods A retrospective evaluation was made of 76 patients who received surgical tracheostomy (group 1) and 78 patients who received percutaneous dilatational tracheostomy (group 2). The patients were evaluated in respect of demographic data, duration of intubation, length of stay in the intensive care unit and discharge status, and after the intervention, the development of tube‐related complications, early stage local complications and late‐stage complications. Results The time from intubation to tracheostomy was determined as 22.73 ± 15.23 days in group 1 and 12.65 ± 7.64 days in group 2. The mortality rate of patients in group 1 was determined to be statistically significantly higher than that of group 2 (P = 0.048). When evaluated in respect to early and late complications, nine early‐ and seven late‐stage complications developed in group 1, and three early‐ and three late‐stage complications developed in group 2 (P = 0.05). In the evaluation of factors related to mortality, the time from intubation to tracheostomy (r = 0.249, P = 0.01) and the presence of a comorbidity (r = 0.325, P = 0.004) were determined to have a positive correlation with the development of mortality. Conclusion Percutaneous dilatational tracheostomy with the flexible lightwand + ultrasonography technique is a safe, rapid and effective method with the advantage of management in respect to early complications, such as bleeding, and can be used safely in the geriatric patient population in intensive care conditions. Geriatr Gerontol Int 2020; ••: ••–••.

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“…We read that the PDT was carried out with the use of ultrasounds to: (i) identify the space between the second and the third cartilage rings; (ii) detect the presence of vascular formation under the chosen site; and (iii) evaluate the distance between the skin and anterior tracheal wall. 1 Furthermore the authors inserted a flexible lightwand, previously marked to reach the root of the cuff, inside the endotracheal tube (ETT) with the aim to withdraw the ETT until the light was located at the level of the thyroid cartilage. 1 We appreciate this promising method to carry out a PDT in critically ill geriatric patients; however, we have some concerns.…”

“…1 Furthermore the authors inserted a flexible lightwand, previously marked to reach the root of the cuff, inside the endotracheal tube (ETT) with the aim to withdraw the ETT until the light was located at the level of the thyroid cartilage. 1 We appreciate this promising method to carry out a PDT in critically ill geriatric patients; however, we have some concerns. First, the authors declared that the use of the flexible lightwand inside an ETT with a minimum internal diameter of 7 mm did not affect the ventilation resistance.…”

“…First, the authors declared that the use of the flexible lightwand inside an ETT with a minimum internal diameter of 7 mm did not affect the ventilation resistance. 1 Fiberoptic bronchoscope (FBS) during PDT was used by 70% of intensive care unit physicians participating in a worldwide survey. 2 The most used FBS during PDT had a diameter of 5 mm.…”

“…1 Fiberoptic bronchoscope (FBS) during PDT was used by 70% of intensive care unit physicians participating in a worldwide survey. 2 The most used FBS during PDT had a diameter of 5 mm. 2 Inserting a FBS of 5 mm inside the ETT increases the resistance to gas flow during simulated mechanical ventilation.…”

“…2 The most used FBS during PDT had a diameter of 5 mm. 2 Inserting a FBS of 5 mm inside the ETT increases the resistance to gas flow during simulated mechanical ventilation. 3 We previously calculated that the crosssectional area of different ETT was reduced by at least 50% by inserting a FBS of 5 mm.…”