Percutaneous versus Open Tracheostomy

Graham, John; Mulloy, Robert H.; Sutherland, Francis; Rose, Sarah

doi:10.1097/00005373-199608000-00008

Cited by 66 publications

(4 citation statements)

References 12 publications

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“…An increasing number of studies reporting results after PDT have appeared in the literature during the last 5 years [2][3][4][5][6][7][8][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. Since the technique was first described, it has been increasingly of interest to physicians caring for critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the increasing use of PDT, concerns about its safety have limited its acceptance by surgeons. Although many reports with sufficient numbers of patients have shown that PDT is as safe as or better than open tracheostomy [13,17,18,30], the blind insertion of rigid dilators is still considered by many to be uncontrolled and dangerous. Furthermore, teaching the procedure has become an issue because it is thought that an experienced operator has essentially little control over the way a trainee advances the dilators.…”

Section: Discussionmentioning

confidence: 99%

“…The PDT technique offers an ideal alternative for ICU-performed tracheostomy. The technique is simple and does not require sophisticated equipment or multiple operators [13][14][15][16][17]. One surgeon can perform it using one of the commercially available PDT kits.…”

mentioning

confidence: 99%

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Bedside Percutaneous Tracheostomy: Prospective Evaluation of a Modification of the Current Technique in 100 Patients

et al. 2000

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Percutaneous dilatational tracheostomy (PDT) is being increasingly used. Concerns have been raised as to its safety, especially when it is done at the bedside. A prospective evaluation was conducted of 100 consecutive, unselected critically ill patients with PDT. The mean intensive care unit (ICU) stay before PDT was 12 days. One surgeon performed PDT alone (5 cases) or assisted residents (95 cases) in all operations; 84 were performed at the ICU bedside. Only the first six patients were taken to the operating room solely for tracheostomy. A modified technique was used: (1) the endotracheal tube was left in place during sequential dilations; (2) dilators were inserted in a 60-degree cephalad orientation to the skin and directed caudally after penetration of the anterior tracheal wall; (3) a digit was inserted through the tracheal opening to guide withdrawal of the endotracheal tube to the level of the vocal cords; and (4) size 8 tracheostomy cannulas were inserted over 28F dilators. The average time from skin incision to insertion of the tracheostomy tube was 12 minutes (< 10 minutes, 41 patients; 10 to 15 minutes, 37 patients; > 15 minutes, 22 patients). Sixty-five percent had unfavorable anatomic conditions due to spinal precautions or diffuse neck edema. Postoperative complications occurred in four patients; surgical emphysema after tracheal lacerations in three, cannula dislodgment in one. All complications were successfully managed without an operation by tube exchange (n = 3) or observation (n = 1); there was no procedure-related mortality. Forty patients were available for long-term follow-up (6-18 months after tracheostomy) by telephone; one had persistent hoarseness without respiratory difficulty. We concluded that bedside PDT is safe and easy to teach when performed with a technique that ensures correct instrumentation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Bedside Percutaneous Tracheostomy: Prospective Evaluation of a Modification of the Current Technique in 100 Patients

et al. 2000

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“…According to the literature [1,[11][12][13], percutaneous tracheostomy is favored over tracheostomy because of wound infections, which are attributed to the more extensive tissue dissection. In our series, we had no problems with wound healing or infection of the incision.…”

Section: Commentsmentioning

confidence: 99%

Modified Technique of Percutaneous Dilational Tracheostomy in 600 Cases

et al. 2002

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Tracheostomy is frequently required for the treatment of critically ill patients to prevent the complications with prolonged translaryngeal intubation. It may facilitate airway suctioning and improve patient comfort during the process of weaning. The purpose of the study was to introduce a new modified technique for percutaneous dilational tracheostomy (MPDT) and assess its advantages. From November 1997 through December 2000, a series of 600 patients (350 men, 250 women; mean age 44.5 years) underwent MPDT in our department. The technique we used is a combination of the Seldinger and Schachner techniques with an incision of 2 to 3 cm between the cricoid cartilage and the notch. Using a small automatic retractor, the thyroid muscles were dissected with the help of a curved mosquito clamp. This gave us the opportunity to control the isthmus and offered the possibility of ligation when the thyroid was large, providing a good operative field directly on the trachea. Hence we avoided traumatizing the isthmus, which is the main source of hemorrhage during this procedure. The mean operating time was 4.5 minutes. The morbidity rate was 0.04%. One patient developed a subcutaneous emphysema and in three cases we had to ligate the external jugular vein. The surgical incision was completely healed within 3 to 4 days after removing the tracheostoma. No tracheal stenoses were observed during the follow-up. MPDT is a safe, applicable technique that can be performed quickly even by a nonsurgeon in the intensive care unit and emergency department, with a low risk of complications because there is a direct view of the trachea and minimal trauma.

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Percutaneous Tracheotomy: Is It Time to Reconsider Our Approach?

Fazekas-May¹

2001

Arch Otolaryngol Head Neck Surg

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Percutaneous versus Open Tracheostomy

Cited by 66 publications

References 12 publications

Bedside Percutaneous Tracheostomy: Prospective Evaluation of a Modification of the Current Technique in 100 Patients

Bedside Percutaneous Tracheostomy: Prospective Evaluation of a Modification of the Current Technique in 100 Patients

Modified Technique of Percutaneous Dilational Tracheostomy in 600 Cases

Percutaneous Tracheotomy: Is It Time to Reconsider Our Approach?

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