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Related Experiment Videos

Experience with percutaneous dilational tracheostomy.

J W Lim1, M Friedman, H Tanyeri

  • 1Department of Otolaryngology and Bronchoesophagology, Rush Medical College, Rush-Prebyterian-St Luke's Medical Center, Chicago, Illinois, USA.

The Annals of Otology, Rhinology, and Laryngology
|September 28, 2000
PubMed
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Percutaneous dilational tracheostomy (PDT) offers acceptable morbidity but no postoperative advantage over standard tracheostomy. Performing PDT in the operating room by a surgeon reduces complications.

Area of Science:

  • Critical Care Medicine
  • Surgical Procedures
  • Respiratory Care

Background:

  • Percutaneous dilational tracheostomy (PDT) has increased in popularity.
  • Initial studies led to concerns about its safety compared to standard operative tracheostomy.
  • Over 1,100 cases of PDT have been reported, with detailed complication data.

Purpose of the Study:

  • To compare the safety and efficacy of PDT versus standard operative tracheostomy.
  • To evaluate the impact of the performing physician (head and neck surgeon vs. critical care physician) on complication rates.

Main Methods:

  • A prospective study involving 311 patients divided into three groups.
  • Group 1: PDT in the operating room by a head and neck surgeon (n=50).
  • Group 2: Standard operative tracheostomy by a head and neck surgeon (n=50).

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  • Group 3: Bedside PDT by critical care physicians (n=211).
  • Intraoperative and postoperative complications were recorded and compared.

    • Main Results:

    • Intraoperative complication rates: Group 1 (0%), Group 2 (2%), Group 3 (4%).
    • Postoperative complication rates: Group 1 (13%), Group 2 (4%), Group 3 (12%).
    • Two deaths occurred in Group 3; none in Groups 1 or 2. Group 1 showed superiority over Group 3 in intraoperative complications.

    Conclusions:

    • PDT can be performed with morbidity rates comparable to published data for standard tracheostomy.
    • PDT offers no advantage over standard tracheostomy regarding postoperative morbidity.
    • Performing tracheostomies (both standard and PDT) by a head and neck surgeon may reduce overall morbidity.