Late sequelae of percutaneous tracheotomy compared to epithelized tracheostomy

Since Ciaglia described in 1985 the method of percutaneous dilational tracheotomy at first time, it has emerged to be a favored used technique in the treatment of critically ill patients to prevent the complications associated with prolonged translaryngeal intubation. There are currently several commercial kits for sequential dilatational percutaneous tracheotomy available. Essential advantages are the simplicity, rapidity, low risk and independence of the physician. But there are also risks for long time complications with essential disadvantages for neurologic and phoniatric rehabilitation.

From September 1997 to September 1999 we examined 168 patients with tracheostoma of three different rehabilitation centers with special attention to early rehabilitation. The examinations included an endoscopic control of the subglottic area, the stoma and the trachea until the bifurcation.

During our examinations we mainly found pathological findings in the subglottic area and the stoma himself with an important difference between the percutaneous tracheotomy and the epithelized tracheostomy.

There is a need for critical indications in performing the percutaneous tracheotomy. We propose its use for short-time only. Critically ill patients with a tracheostoma in requirement of a airway bypass more than 6 weeks should get an epithelized tracheostomy primarily.