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Percutaneous versus surgical tracheostomy: a double-blind randomized trial
C Gysin1, P Dulguerov, J P Guyot
1Department of Otolaryngology-Head and Neck Surgey, Geneva University Hospital, Switzerland.
Annals of Surgery
|November 24, 1999
Summary
This study compared surgical (SgT) and percutaneous (PcT) tracheostomies, finding both safe with experienced surgeons. Percutaneous tracheostomy had smaller incisions but more minor perioperative complications, while surgical tracheostomy had more long-term scarring.
Area of Science:
- Critical Care Medicine
- Surgical Procedures
- Airway Management
Background:
- Percutaneous tracheostomy (PcT) is often cited for advantages over surgical tracheostomy (SgT).
- Direct comparison through rigorous methodology is essential to validate these claims.
Purpose of the Study:
- To prospectively compare the safety and efficacy of surgical tracheostomy (SgT) versus percutaneous tracheostomy (PcT).
Main Methods:
- A prospective, randomized, double-blind trial involving 70 patients undergoing either SgT or PcT.
- Evaluation of procedure-related variables, perioperative, and postoperative complications by blinded assessors.
- Assessment included short-term (14 days) and long-term (3 months) outcomes.
Main Results:
- No statistically significant difference in major complications between PcT and SgT groups.
- PcT resulted in smaller incision size (p < 0.0001) but more minor perioperative complications (p = 0.02).
- Difficult cannula changes were more frequent with PcT (p < 0.05), while SgT had more long-term unesthetic scars.
Conclusions:
- Both SgT and PcT demonstrate low rates of serious or intermediate complications when performed by experienced surgeons.
- PcT is associated with more minor perioperative complications.
- SgT is associated with more minor long-term complications, specifically unesthetic scarring.