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Online ISSN 1827-1596
CRITICAL AND INTENSIVE THERAPY
Muttini S. 1, Melloni G. 2, Gemma M. 3, Casati A. 1, Carretta A. 2, Giudici D. 1, Cozzi S. 3, Chiesa G. 2, Gallioli G. 1, Beretta L. 3, Casaletti E. 1, Torri G. 1
1 Università degli Studi - Milano, IRCCS H San Raffaele - Milano, Servizio di Anestesia e Rianimazione;
2 Università degli Studi - Milano, IRCCS H San Raffaele - Milano, Divisione di Chirurgia Toracica;
3 Università degli Studi - Milano, IRCCS H San Raffaele - Milano, Servizio di Neurorianimazione
Background. To compare early and late complications after either conventional surgical or percutaneous dilatational tracheostomy. Design: prospective, randomized study. Setting: general intensive care unit and neuro-surgical intensive care unit in a university hospital. Patients: 50 consecutive patients, requiring tracheostomy for prolonged mechanical ventilation. Interventions and measurements: patients were randomly allocated to receive either surgical (surgical group, n=25) or percutaneous dilatational tracheostomy (percutaneous group, n=25). Occurrence of perioperative complication were carefully evaluated during ICU stay. Late complications were evaluated with both physical and endoscopic examination at 1, 3 to 6 months after tracheostomy.
Results. All surgical and percutaneous tracheostomies were successfully completed and no deaths directly related to the tracheostomy procedures were reported. Completion of the procedure required 41±14 min in the surgical group and 14±6 min in the percutaneous one (p<0.0001). The incidence of early perioperative complications was higher in the surgical group (36%) than in percutanous one (12%), (p<0.05). The endoscopic follow-up demonstrated one segmental malacia and one stenosis of the trachea in the percutaneous group only (p=n.s.). Skin repair was better after percutaneous tracheostomy than in the surgical group (p<0.01).
Conclusions. In experienced hands, percutaneous dilatational tracheostomy is as safe and effective as the conventional surgical tracheostomy. The percutaneous technique is less time-consuming and has a lower rate of early infectious complications with better cosmetic results than the surgical technique.