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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2002 February;43(1):113-21

lingua: Inglese

Surgical tracheostomy versus percutaneous dilatational tracheostomy. A prospective-randomized study with long-term follow-up

Melloni G., Muttini S. *, Gallioli G. *, Carretta A., Cozzi S., Gemma M. *, Zannini P.

From ­the Department of Thoracic Surgery
*Department of Anesthesia Vita-Salute San Raffaele University San Raffaele Scientific Institute, Milan, Italy


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Background. To com­pare sur­gi­cal trach­e­os­to­my (ST) ver­sus per­cut­ane­ous dil­a­ta­tion­al trach­e­os­to­my (­PDT) in ­terms of com­pli­ca­tion ­rates. In par­tic­u­lar we spe­cif­i­cal­ly stud­ied ­the ­late tra­cheal com­pli­ca­tions of ­both meth­ods by ­means of endo­scop­ic con­trols of ­patients up to 6 ­months ­after ­the pro­ce­dures.
Methods. Design: pros­pec­tive-ran­dom­ized clin­i­cal ­study. Setting: University-affil­i­at­ed ter­tiary ­care refer­ral hos­pi­tal. Patients: 50 con­sec­u­tive trans­la­ryn­geal­ly intu­bat­ed ­patients ­with res­pir­a­to­ry fail­ure ­were ran­dom­ized to under­go ­either ST (25 ­patients) or endo­scop­ic guid­ed ­PDT (25 ­patients).
Results. ST ­was per­formed in 41±14 ­min ver­sus 14±6 ­min ­for ­PDT (p<0.0001). There ­was no pro­ce­dure-relat­ed ­death. In ­the ST ­group ­there ­were no intra­op­er­a­tive com­pli­ca­tions. In ­the ­PDT ­group 2 intra­op­er­a­tive com­pli­ca­tions (­minor hem­or­rhag­es) ­were ­observed. In ­the ST ­group 9 ear­ly post­op­er­a­tive com­pli­ca­tions ­occurred: ­one ­minor bleed­ing, 7 sto­mal infec­tions ­and ­one acci­den­tal decan­nu­la­tion. In ­the ­PDT ­group ­only ­one ear­ly post­op­er­a­tive com­pli­ca­tion (­minor bleed­ing) ­occurred. Early post­op­er­a­tive com­pli­ca­tion ­rates ­were 36% ­for ST ­and 4% ­for ­PDT. In ­the ST ­group ­there ­were no ­late tra­cheal com­pli­ca­tions. In ­the ­PDT ­group 2 ­late tra­cheal com­pli­ca­tions (­one seg­men­tal mal­a­cia ­and ­one sten­o­sis at ­the lev­el of ­the sto­ma) ­were ­observed.
Conclusions. This ­study con­firms ­that ­PDT is a sim­pler ­and quick­er pro­ce­dure ­than ST ­and ­that it ­has a low­er ­rate of ear­ly post­op­er­a­tive com­pli­ca­tions. Late tra­cheal com­pli­ca­tions ­were ­more fre­quent, ­although ­the dif­fer­ence ­was ­not sta­tis­ti­cal­ly-sig­nif­i­cant, in ­the ­PDT ­group. Further inves­ti­ga­tions of ­long-­term out­come fol­low­ing ­PDT ­are there­fore nec­es­sary.

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