Evaluation of the Safety of Percutaneous Dilational Tracheostomy Compared with Surgical Tracheostomy in the Intensive Care Unit

Abstract

Background Tracheostomy is a necessary procedure for patients who require long-term mechanical ventilation support. There are two methods for tracheostomy in current use: surgical tracheostomy (ST) and percutaneous dilational tracheostomy (PDT). In the current study, we retrospectively compared the safety of both procedures performed in our intensive care unit (ICU). Methods In this study, we enrolled subjects who underwent tracheostomy in our ICU between January 2012 and March 2016. We excluded subjects who were <20 years old and underwent tracheostomy in the operating room. As a primary outcome, we evaluated the rate of complications between ST and PDT groups. The length of ICU stay, time to tracheostomy from intubation, and the rate of mechanical ventilation and mortality at 28 postoperative days were also examined as secondary outcomes. Results Compared with the ST group, the rate of all complications was lower in the PDT group (13.4% vs. 38.8%, p=0.007). Although the rate of intraoperative complications did not differ between the two groups (3.8% vs. 8.1%, p=0.62), relative to the ST procedure, the PDT procedure was associated with fewer postoperative complications (34.6% vs. 9.6%, p=0.003). Among postoperative complications, accidental removal of the tracheostomy tube and an air leak from the tracheostomy fistula were less frequent in the PDT group than the ST group. Between the two groups, there were no significant differences in their secondary outcomes. Conclusion This retrospective study indicates that relative to ST, PDT is a safer procedure to be performed in the ICU. Fewer postoperative complications following PDT might be attributed to the small skin incision made during this procedure.

Effect of Patient Demographics and Tracheostomy Timing and Technique on Patient Survival

“…For example, a cohort study by Suzuki et al found rates of all complications to be lower in the PT group when compared to the non-PT group, including infection and air leak, consistent with our findings. 24 A Cochrane review by Brass et al found decreased risk of complications such as infection and tracheoesophageal fistula formation in PT patients but no difference in bleeding complications, further corroborating our results. 13 Additionally, there were five causes of tracheostomy-related deaths in the LT group, compared to just one (hemorrhage) in the ET group.…”

Open Bedside Tracheostomy: Safe and Cost Saving but Underutilized Nationally

“…32 The teams at LAC and Keck Hospital are multidisciplinary, with the participation of the ICU nurse and respiratory therapy during the surgery and the intensivist and speech language pathologists postoperatively. Regarding long-term complications, some studies state that PDT has a lower complication rate than OBT, 4,31 while other studies note that PDT has more complications. 7,33 We believe that these conflicting data are due to the lack of long-term followup with patients after tracheostomy.…”

“…This is consistent with the current literature, which shows similar intraoperative complications among all 3 modalities. 25,30,31 The data for long-term postoperative complications for PDT vs OR tracheostomy and OBT are more controversial. For complications within 7 days, multiple studies support the finding that PDT and OBT have similar complication rates.…”

The Feasibility of Percutaneous Dilatational Tracheostomy in Immunosuppressed ICU Patients with or without Thrombocytopenia

“…PDT leads to a close fitting of the tracheal cannula to the stoma; humid wound conditions are sporadic. Suzuki et al concluded in their study that the small skin incision during the PDT procedure leads to fewer postoperative complications and is, therefore, a safer procedure than OST to be performed in ICU [ 24 ].…”