Search

Background The tracheostomy is an oldest invasive procedure done for critically ill patients. Now, it is usually performed for better weaning and less risk of intubation-related complications either surgically intraoperative or percutaneous procedure which is easily performed at the bedside by an intensivist. The aim of this study is to compare between surgical and percutaneous tracheostomy (PT) in critically ill patients with prolonged ventilation who needed tracheostomy. Methods This randomized controlled study was done at the respiratory ICU - Chest Department, Operating Room of the Otorhinolaryngology Department at Tanta University Hospitals, and respiratory ICU Air Forces Hospital. 30 critically ill patients with prolonged mechanical ventilation were divided into two groups. Group I (15 patients) underwent surgical tracheostomy (ST) and group II (15 patients) underwent fiberoptic bronchoscopic-guided PT, from August 2020 to December 2021. Results 30 patients were enrolled in this study. Neck circumference (cm) was significantly higher in surgical group (P = 0.013). Also, the most important is that the duration of procedure is shorter in percutaneous group (P < 0.001). Regarding delayed complications were insignificantly different between both groups except for stomal infection which was higher in surgical group (P = 0.042). Regarding secondary outcomes of the procedure, successful decannulation, permanent tracheostomy, and death due to primary disease were insignificantly different between the studied groups. Conclusion Percutaneous tracheostomy is safer, faster, time saving and less complicated than surgical tracheostomy.

Background The tracheostomy is an oldest invasive procedure done for critically ill patients. Now, it is usually performed for better weaning and less risk of intubation-related complications either surgically intraoperative or percutaneous procedure which is easily performed at the bedside by an intensivist. The aim of this study is to compare between surgical and percutaneous tracheostomy (PT) in critically ill patients with prolonged ventilation who needed tracheostomy. Methods This randomized controlled study was done at the respiratory ICU - Chest Department, Operating Room of the Otorhinolaryngology Department at Tanta University Hospitals, and respiratory ICU Air Forces Hospital. 30 critically ill patients with prolonged mechanical ventilation were divided into two groups. Group I (15 patients) underwent surgical tracheostomy (ST) and group II (15 patients) underwent fiberoptic bronchoscopic-guided PT, from August 2020 to December 2021. Results 30 patients were enrolled in this study. Neck circumference (cm) was significantly higher in surgical group (P = 0.013). Also, the most important is that the duration of procedure is shorter in percutaneous group (P < 0.001). Regarding delayed complications were insignificantly different between both groups except for stomal infection which was higher in surgical group (P = 0.042). Regarding secondary outcomes of the procedure, successful decannulation, permanent tracheostomy, and death due to primary disease were insignificantly different between the studied groups. Conclusion Percutaneous tracheostomy is safer, faster, time saving and less complicated than surgical tracheostomy. [ABSTRACT FROM AUTHOR]

Background: Some patients on extracorporeal membrane oxygenation (ECMO) require prolonged mechanical ventilation. An early tracheostomy strategy while on ECMO has appeared to be beneficial for these patients. This study aims to explore the safety of tracheostomy in ECMO patients. Methods: This is a retrospective observational single‐center study. Results: Hundred and nine patients underwent tracheostomy (76 percutaneous and 33 surgical) during V‐V ECMO support over an 8‐year period. Patients with a percutaneous tracheostomy showed a significantly shorter ECMO duration [25.5 (17.3–40.1) vs 37.2 (26.5–53.2) days, p = 0.013] and a shorter ECMO‐to‐tracheostomy time [13.3 (8.5–19.7) vs 27.8 (16.3–36.9) days, p < 0.001] compared to those who underwent a surgical approach. There was no difference between the two strategies regarding both major and minor/no bleeding (p = 0.756). There was no difference in survival rate between patients who underwent percutaneous or surgical tracheostomy (p = 0.173). Patients who underwent an early tracheostomy (within 10 days from ECMO insertion) showed a significantly shorter hospital stay (p < 0.001) and a shorter duration of V‐V ECMO support (p < 0.001). Our series includes 24 patients affected by COVID‐19, who did not show significantly higher rates of major bleeding when compared to non‐COVID‐19 patients (p = 0.297). Within the COVID‐19 subgroup, there was no difference in major bleeding rates between surgical and percutaneous approach (p = 1.0). Conclusions: Percutaneous and surgical tracheostomy during ECMO have a similar safety profile in terms of bleeding risk and mortality. Percutaneous tracheostomy may favor a shorter duration of ECMO support and hospital stay and can be considered a safe alternative to surgical tracheostomy, even in COVID‐19 patients, if relevant clinical expertise is available. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to evaluate the advantages and disadvantages,complication and mortality rates of percutaneous and surgical tracheostomy procedures performed in patients in neuro-intensive care unit (neuro-ICU). Materials and Methods: The study was carried out retrospectively in neuro-ICU. Patients' demographic characteristics, comorbidities, reasons for hospitalization, ICU scores at admission [Acute Physiology and Chronic Health Evluation 2 (APACHE 2) score and Sequential Organ Failure Assessment (SOFA) score], intubation period (days), length of stay in ICU, procedural complications, mortality rates, modified Rankin scale (mRS) scores at discharge and 3rd month were evaluated. Surgical and percutaneous tracheostomy results were compared. Laryngeal mask airway (LMA), bronchoscopy, and tube withdrawal procedures used in percutaneous tracheostomy were compared as well. Results: Fifty five patients were included in the study. Of the patients, 60.0% were male. Mean age was 71.4+-11.8 years. The APACHE 2 score was 25.4+-4.8 and SOFA score was 8.1+-2.7 at admission to ICU. Mean number of intubation days of the patients was 20.7+-11.8, and mean length of stay in ICU was 33.1+-13.0 days. Tracheostomy procedure was successful in 53 (96.4%) patients, complications were encountered in 5 (9.1%) patients among all (succesful and unsuccessful) intervention groups. Mortality was seen in 23 (41.8%) patients. Three-month mRS was 5 in 32 (%58.2) patients. Duration of stay in ICU, intubation period (days), and time between intensive care hospitalization and tracheostomy (days) in surgery group were significantly longer compared to percutaneous tracheostomy group. No statistically significant difference was observed in comparison of different groups such as LMA, tube withdrawal, bronchoscopy in patients undergoing percutaneous tracheostomy. Conclusion: In the study in which we compared the surgical and percutaneous tracheostomy results, no statistically significant difference was found in the complication rates and mRS score at discharge of the two groups. In-hospital mortality rate, which was defined as mRS 6, was observed to be higher in patients who underwent surgical tracheostomy. Because of the rapid application of the procedure at the bedside in patients for whom percutaneous tracheostomy was preferred, it was observed that the length of stay in the neuro-ICU and the number of days followed up with intubation were reduced.

Objective: The aim of the study is to evaluate the advantages and disadvantages,complication and mortality rates of percutaneous and surgical tracheostomy procedures performed in patients in neuro-intensive care unit (neuro-ICU). Materials and Methods: The study was carried out retrospectively in neuro-ICU. Patients' demographic characteristics, comorbidities, reasons for hospitalization, ICU scores at admission [Acute Physiology and Chronic Health Evluation 2 (APACHE 2) score and Sequential Organ Failure Assessment (SOFA) score], intubation period (days), length of stay in ICU, procedural complications, mortality rates, modified Rankin scale (mRS) scores at discharge and 3rd month were evaluated. Surgical and percutaneous tracheostomy results were compared. Laryngeal mask airway (LMA), bronchoscopy, and tube withdrawal procedures used in percutaneous tracheostomy were compared as well. Results: Fifty five patients were included in the study. Of the patients, 60.0% were male. Mean age was 71.4±11.8 years. The APACHE 2 score was 25.4±4.8 and SOFA score was 8.1±2.7 at admission to ICU. Mean number of intubation days of the patients was 20.7±11.8, and mean length of stay in ICU was 33.1±13.0 days. Tracheostomy procedure was successful in 53 (96.4%) patients, complications were encountered in 5 (9.1%) patients among all (succesful and unsuccessful) intervention groups. Mortality was seen in 23 (41.8%) patients. Three-month mRS was 5 in 32 (%58.2) patients. Duration of stay in ICU, intubation period (days), and time between intensive care hospitalization and tracheostomy (days) in surgery group were significantly longer compared to percutaneous tracheostomy group. No statistically significant difference was observed in comparison of different groups such as LMA, tube withdrawal, bronchoscopy in patients undergoing percutaneous tracheostomy. Conclusion: In the study in which we compared the surgical and percutaneous tracheostomy results, no statistically significant difference was found in the complication rates and mRS score at discharge of the two groups. In-hospital mortality rate, which was defined as mRS 6, was observed to be higher in patients who underwent surgical tracheostomy. Because of the rapid application of the procedure at the bedside in patients for whom percutaneous tracheostomy was preferred, it was observed that the length of stay in the neuro-ICU and the number of days followed up with intubation were reduced. [ABSTRACT FROM AUTHOR]

The percutaneous dilatation tracheostomy (PDT) using the Seldinger technique was developed a few decades ago and gained popularity. PDT has become a more convenient technique for intensive care units (ICU) patients across the world. The present work aims to share our experience as ENT surgeons in performing a percutaneous tracheostomy. A series of eight patients were included in the study. ICU patients on mechanical ventilation more than 14 days were ideal candidates for PDT. The invention of PDT had overcome many obstacles found in the surgical tracheostomy (ST) procedure. PDT can be performed as a bedside procedure which saves both time and cost of operating theatres.

A systematic review and meta-analysis of the entire COVID-19 Tracheostomy cohort was conducted to determine the cumulative incidence of complications, mortality, time to decannulation and ventilatory weaning. Outcomes of surgical versus percutaneous and outcomes relative to tracheostomy timing were also analysed. Studies reporting outcome data on patients with COVID-19 undergoing tracheostomy were identified and screened by 2 independent reviewers. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Outcome data were analysed using a random-effects model. From 1016 unique studies, 39 articles reporting outcomes for a total of 3929 patients were included for meta-analysis. Weighted mean follow-up time was 42.03 ± 26 days post-tracheostomy. Meta-analysis showed that 61.2% of patients were weaned from mechanical ventilation [95%CI 52.6%–69.5%], 44.2% of patients were decannulated [95%CI 33.96%–54.67%], and cumulative mortality was found to be 19.23% [95%CI 15.2%–23.6%] across the entire tracheostomy cohort. The cumulative incidence of complications was 14.24% [95%CI 9.6%–19.6%], with bleeding accounting for 52% of all complications. No difference was found in incidence of mortality (RR1.96; p = 0.34), decannulation (RR1.35, p = 0.27), complications (RR0.75, p = 0.09) and time to decannulation (SMD 0.46, p = 0.68) between percutaneous and surgical tracheostomy. Moreover, no difference was found in mortality (RR1.57, p = 0.43) between early and late tracheostomy, and timing of tracheostomy did not predict time to decannulation. Ten confirmed nosocomial staff infections were reported from 1398 tracheostomies. This study provides an overview of outcomes of tracheostomy in COVID-19 patients, and contributes to our understanding of tracheostomy decisions in this patient cohort. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic placed an unprecedented demand on critical care services for the provision of mechanical ventilation. Tracheostomy formation facilitates liberation from mechanical ventilation with advantages for both the patient and wider critical care resource, and can be performed using both percutaneous dilatational and surgical techniques. We compared outcomes in those patients undergoing percutaneous dilatational tracheostomy to those undergoing surgical tracheostomy and make recommendations for provision of tracheostomy services in any future surge. Methods: Multicentre multidisciplinary retrospective observational cohort study including 201 patients with COVID-19 pneumonitis admitted to an ICU in one of five NHS Trusts within the South London Adult Critical Care Network who required mechanical ventilation and subsequent tracheostomy. Results: Percutaneous dilatational tracheostomy was performed in 124 (62%) of patients, and surgical tracheostomy in 77 (38%) of patients. There was no difference between percutaneous dilatational tracheostomy and surgical tracheostomy in either the rate of peri-operative complications (16.9 vs. 22.1%, p = 0.46), median [IQR(range)] time to decannulation [19.0 (15.0–30.2 (5.0–65.0)] vs. 21.0 [15.5–36.0 (5.0–70.0) days] or mortality (13.7% vs. 15.6%, p = 0.84). Of the 172 patients that were alive at follow-up, two remained ventilated and 163 were decannulated. Conclusion: In patients with COVID-19 pneumonitis that require tracheostomy to facilitate weaning from mechanical ventilation, there was no difference in outcomes between those patients that had percutaneous dilatational tracheostomy compared with those that had surgical tracheostomy. Planning for future surges in COVID-19-related critical care demands should utilise all available resource and expertise. [ABSTRACT FROM AUTHOR]

Tracheal stenosis is a late and usually non-life threatening complication of surgical and percutaneous tracheostomies (PDT) as well as delayed endotracheal extubation. We undertook a retrospective review of all patients who underwent a surgical tracheostomy over a 10 year period. Patients were included in the study if they had CT or MRI imaging of the tracheostomy site both pre-operatively and six or more weeks post operatively. Patients whose imaging was not available were excluded (n = 3) as were those patients who still had a tracheostomy in situ (n = 8). In total 91 patients were included in the study. In the same period 1170 surgical tracheostomies were performed by the maxillofacial surgeons. The images were analysed by a radiologist and the degree of stenosis reported. All 91 patients underwent a tracheostomy with a window. 83 patients did not demonstrate any stenosis. Looking at the remaining 8 patients with stenosis: 6 patients had stenosis of less than 25%, 1 patient had stenosis between 25-50% and 1 patient had stenosis greater than 50%. Both patients with stenosis greater than 25% had more than one surgical tracheostomy. We have shown that the risk of stenosis is 8.8%, lower than often quoted in literature, and when it occurs it is likely to be symptomatic only in severe stenosis. Our main risk of stenosis was repeat surgical tracheostomies which also seems to be linked to a greater degree of stenosis. [ABSTRACT FROM AUTHOR]

The percutaneous dilatation tracheostomy (PDT) using the Seldinger technique was developed a few decades ago and gained popularity. PDT has become a more convenient technique for intensive care units (ICU) patients across the world. The present work aims to share our experience as ENT surgeons in performing a percutaneous tracheostomy. A series of eight patients were included in the study. ICU patients on mechanical ventilation more than 14 days were ideal candidates for PDT. The invention of PDT had overcome many obstacles found in the surgical tracheostomy (ST) procedure. PDT can be performed as a bedside procedure which saves both time and cost of operating theatres. [ABSTRACT FROM AUTHOR]

Konrad Jarosz,1 Bartosz Kubisa,2 Agata Andrzejewska,3 Katarzyna Mrówczyńska,3 Zbigniew Hamerlak,4 Alicja Bartkowska-Śniatkowska5 1Department of Clinical Nursing, Pomeranian Medical University, 2Thoracic Surgery and Transplantation Department, Pomeranian Medical University, 3Anaesthesiology and Intensive Care Department, Pomeranian Medical University, 4Stomatology Department, Pomeranian Medical University, 5Anaesthesiology and Pediatric Intensive Care Department, Poznan University of Medical Sciences, Szczecin, Poland Abstract: Tracheostomy is a routinely done procedure in the setting of intensive care unit (ICU) in patients requiring prolonged mechanical ventilation. There are two ways of making a tracheostomy: an open surgical tracheostomy and percutaneous dilatational tracheostomy. Percutaneous dilatational tracheostomy is associated with fewer complications than open tracheostomy. In this study, we would like to compare both techniques of performing a tracheostomy in ICU patients and to present possible complications, methods of diagnosing and treating and minimizing their risk. Keywords: tracheostomy, percutaneous tracheostomy, percutaneous dilatational tracheostomy, bronchoscopy, surgical tracheostomy, tracheoesophageal fistula, tracheostomy complications

Introduction Tracheostomy is one of the frequent surgical procedure carried out in intensive care unit. Percutaneous tracheostomy is becoming increasingly popular compared to conventional open surgical tracheostomy in ICU. Methods A prospective randomized trial with twenty patients in each group was conducted to compare the outcomes of percutaneous and surgical tracheostomy. Percutaneous tracheostomy was performed using Ciaglia Blue Rhino technique and surgical tracheostomy was performed using established technique. The outcomes were compared in relation to randomization to tracheostomy, completion of procedure, intra operative and post-operative complications, hospital length of stay and cost. Results There were no major complications in either group. Most variables studied were not statistically significant. The two groups did not differ in terms of basic demographics or APACHE II score. The only variables to reach statistical significance were time duration from tracheostomy randomization to start of procedure and time taken for completion of procedure. It was mean 31.85±15.35 hours in Percutaneous Tracheostomy group and in Surgical Tracheostomy group it was mean 49.10±23.61 hours respectively (p<0.009). Time taken to perform percutaneous tracheostomy was mean 15.50±3.22 minutes and for surgical tracheostomy it was mean 20.30±3.38 minutes. (p<0.001). Conclusion Percutaneous dilatational tracheostomy is simple, faster to perform and can be done at bedside to avoid considerable delay in the performance of open tracheostomy where there is high demand for elective and emergency procedures in operating room. [ABSTRACT FROM AUTHOR]

Tracheostomy is a commonly performed surgical procedure in intensive care units (ICUs). Over the past three decades, there has been a substantial body of evidence to suggest percutaneous tracheostomy (PT) is at least as safe as surgical tracheostomy (ST) in the hands of trained clinicians. In most institutions, PT is more readily performed at bedside than ST in the ICU; hence, PT is an attractive alternative to ST in the ICU. Bedside PT generates significant cost savings by eliminating operating room and anesthesia charges. Bronchoscopy is commonly used as a visual aid during PT. Ultrasound (US)-guided PT is gaining popularity. It can be used as an adjunct or alternative to bronchoscopic-guided PT, especially in hospitals where access to bronchoscopy remains fairly limited and US is more widely available. There are many benefits in converting translaryngeal intubation to tracheostomy. It is widely accepted that tracheostomy is preferred if there is an anticipation of prolonged need for an artificial airway. The timing of this conversion from translaryngeal intubation to tracheostomy remains a subject of controversy. Limited data are available regarding the safety of PT on patients who are on dual antiplatelet therapy or active anticoagulation. Given the heterogeneity of PT techniques, adequate training and experience with the technique, coupled with careful planning are essential in minimizing any potential complication. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: The purpose of this study was to compare timing of procedure, patient characteristics, outcomes, and charges for patients who underwent percutaneous versus surgical tracheostomy.Study Design: Retrospective cohort study.Methods: A retrospective analysis was performed for all patients who underwent tracheostomy in 2015 to 2016 in New York State. Patients were identified using International Classification of Diseases, 10th Revision, Clinical Modification codes and stratified to the type of tracheostomy performed. The primary outcome of interest was mortality at index stay. Secondary outcomes of interest included length of stay and total hospitalization charges.Results: Of the 8,682 patients, 2,488 (28.7%) underwent percutaneous and 6,194 (71.3%) underwent surgical tracheostomy. At hospitals where both procedures were performed, percutaneous tracheostomy patients were older, had more comorbidities, and had lower income (P < .05). Timing of the tracheostomy relative to admission did not affect the type of tracheostomy performed. While controlling for patient characteristics and complications during the visit, percutaneous tracheostomy was associated with increased mortality (odds ratio [OR]: 1.17, 95% confidence interval [CI]: 1.03-1.33, P = .0153) and increased hospital charges (OR: + 7.76%, 95% CI: 5.4-10.11, P < .0001). Length of stay was not affected by procedure type.Conclusions: Surgical tracheostomies are more commonly performed than percutaneous tracheostomies across New York State. Older, lower-income, and sicker patients have a higher chance of receiving percutaneous tracheostomies. Percutaneous approaches were associated with statistically significant increased mortality and higher charges despite no difference in length of stay. Further studies are needed to determine if these differences in outcomes are clinically significant.Level Of Evidence: NA Laryngoscope, 128:2844-2851, 2018. [ABSTRACT FROM AUTHOR]

Tracheostomy is one of the most common procedures undertaken in critically ill patients. It offers many theoretical advantages over translaryngeal intubation. Recent evidence in a heterogeneous group of critically ill patients, however, has not demonstrated a benefit for tracheostomy, in terms of mortality, length of stay in Intensive Care Unit (ICU), or incidence of ventilator‑associated pneumonia. It may be a beneficial intervention in articular subsets of ICU patients. In this article, we will focus on the evidence for the timing of tracheostomy and its effect on various subgroups of patients in critical care. [ABSTRACT FROM AUTHOR]

Although percutaneous tracheostomy is a standardized procedure, rare major complications are still being evaluated and discussed. We describe a case of patient, with hemodynamic and respiratory stability, who displayed massive hemorrhage after 16 days of “Ciaglia Blue Rhino” tracheostomy. Unfortunately, neither prompt resuscitation maneuvers nor the surgical approach saved the life of patient.

Objective: In the last 3 years, intensive care unit patients who had undergone percutaneous tracheostomy and surgical tracheostomy retrospectively were evaluated to determine the differences between the two methods in terms of complications. Methods: Patients who had been hospitalised in the intensive care unit in the last 3 years, with ages ranging from 18-65, who were intubated and had undergone tracheostomy were included in the study. Patients were divided into two groups: those with percutaneous tracheostomy and those with surgical tracheostomy. From the last 3 years, patients who had full data in the file were included in the study; the number of patients with surgical tracheostomy was 104, and the number of patients with percutaneous tracheostomy was 99. All data were obtained from patient charts, forms, and daily patient follow-up examination forms. Demographic characteristics of the patients and the Glasgow Coma Scale (GCS) data were recorded from the patient file and haemodynamic data, blood gas values, haemoglobin values of before and 1 day after the procedure were recorded. Any additional complications were also recorded. Results: Haemoglobin values after the procedure were significantly lower than values before the initiation of procedure in the surgical tracheostomy group but not in the percutaneous tracheostomy group. In the surgical tracheostomy group, 20 of 104 patients had bleeding after the procedure; there was repetition of endotracheal intubation in 22 patients during the acute phase, and subcutaneous emphysema was observed in 18. Bleeding was recorded in patients with percutaneous tracheostomy in 5 out of 99 patients, repetition of endotracheal intubation was performed in 7, and subcutaneous emphysema was observed in 5. Conclusion: The percutaneous tracheostomy technique, in terms of postoperative complications and bleeding, gives better results than surgical tracheostomy and could be used widely as a routine method for elective tracheostomy in intensive care units. [ABSTRACT FROM AUTHOR]

Background: The steady rise in the number of critically ill patients in the USA has led to an increase in the need for tracheostomies in patients requiring chronic ventilatory support. There is a matched need for experienced operators to safely and efficiently perform these procedures. Objectives: We evaluated the effects on procedural outcomes and efficiency of percutaneous dilatational tracheostomy (PDT) placement in the medical intensive care unit (MICU) by the surgical team (ST) or interventional pulmonologists (IP). The IP team joined the PDT team in September 2007 and became primarily responsible for all PDT in the MICU. Methods: A retrospective analysis of prospectively collected data of patients who received PDT in the MICU by ST and IP from September 2007 to August 2010 was made. Outcomes including safety, efficacy, and procedural efficiency were compared. Results: One hundred seven patients underwent bedside PDT in the MICU during this period. Forty-three procedures (40.2%) were performed by the ST and 64 procedures (59.8%) were performed by IP. There was no statistical difference between the incidence of airway injury and infection between the two procedural groups. There were no deaths related to the performance of PDT in our series. PDT was completed within 48 h of request in 100% of IP patients and 95% of ST patients (p = 0.08). Conclusions: There were no statistical differences in PDT between the ST and IP groups when comparing complications. There was a trend towards an increased efficiency in time to PDT after consultation within the IP PDT group. Trained IP can safely and effectively perform PDT. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Background: A retrospective review of our experience with percutaneous tracheostomy was performed to determine our complication rate and pattern of use since this modality was introduced at our institution. Methods: A retrospective chart review captured all patients in whom tracheostomy was performed or supervised by a trauma/critical care faculty member. Dates of hospital admission, ICU admission, intubation, discontinuation of mechanical ventilation, type and location of procedure, procedural complications, Injury Severity Score, charges, and patient demographics were collected. Percutaneous tracheostomy (PT) and open tracheostomy (OT) experiences were compared. Results: Three hundred sixty-eight tracheostomies were performed (190 OT and 178 PT). The average time to tracheostomy (TTT) for PT patients decreased from 12.7 to 7.4 days. The average TTT for OT patients remained stable at 14.0 days. The complication rate was 3.5%, with 4 complications (1.5%) associated with OT and 9 complications (5.1%) associated with PT. All complications in the PT group occurred before using a single dilator system. The 9 complications in the PT group occurred among 5 surgeons, all before their 11th attempt. PT saves $444 in charges per procedure. Conclusion: OT continues to be a safe method of performing tracheostomies. PT has a steep learning curve but can be mastered quickly. Benefits include a shorter time to tracheostomy, elimination of patient transport, and saving in charges. Initial PT attempts should be supervised by an experienced surgeon. [Copyright &y& Elsevier]

Study objective: To compare the surgical findings of tracheal stenosis caused by percutaneous tracheostomy (PCT) and surgical tracheostomy (SGT). Design and setting: A combined prospective (from 2001 to 2003) and retrospective (from 1993 to 2001) observational study of the patients undergoing tracheal resection and reconstruction for treatment of tracheal stenosis following PCT or SGT in a national referral center for thoracic surgery in the United Kingdom. Patients and measurements: We studied 29 patients presenting with symptomatic tracheal stenosis requiring tracheal reconstruction. We recorded the demographic data, duration of mechanical ventilation, onset of tracheal stenosis after decannulation, and type of tracheostomy (PCT or SGT) from referral notes. Tracheal reconstruction was preceded by rigid bronchoscopy, through which the distance of the superior level of stenosis to the vocal cords, and the length and the diameter of stenosis were measured. The type of surgical technique for tracheal resection was also recorded. We then compared the stenosis caused by PCT (n = 15) and SGT (n = 14) using an unpaired t test, Mann-Whitney t test, or Fisher exact test as appropriate for statistical analysis. Results: The mean distance from the superior level of stenosis in the PCT group was significantly closer to the vocal cords compared with the mean distance in the SGT group: 1.6 cm (95% confidence interval [CI], 1.1 to 2.1) vs 3.4 cm (95% CI, 2.3 to 4.5), respectively (p = 0.04). The mean onset of stenosis was significantly earlier in the PCT group compared to the SGT group: 5.0 weeks (95% CI, 5.0 to 6.0) vs 28.5 weeks (95% CI, 12 to 84), respectively (p = 0.009). Seven of 15 patients in the PCT group required partial cricoid resection and a mucosal flap, compared with 1 of 14 patients in the SGT group, although the difference did not reach statistic significance (p = 0.23). Conclusion: Stenosis caused by PCT occurred earlier and was subglottic in nature compared to that by SGT. Surgical correction of stenosis was more difficult in the PCT group due to its presentation in the subglottic area. [ABSTRACT FROM AUTHOR]