[Complications of tracheostomy in critically ill patients: comparison of dilation and surgical techniques]

The tracheotomy, one of the oldest surgical procedures, has in recent years been the focus of particular attention given the undoubted, and not always justified, increase in indications, and by the introduction of dilatational tracheotomy techniques, particularly in critically patients. The present work compares the standard surgical tracheotomy with the more recent percutaneous techniques (Ciaglia dilatational tracheotomy and Fantoni translaryngeal tracheotomy). In particular, the relationship between the technique adopted, timing and complications were analyzed for 215 tracheotomies performed at different Intensive Care Units at our Hospital between 1993 and 1998 (106 performed using the standard surgical technique, 51 with the Ciaglia technique and 58 with the Fantoni technique). The pre-operative oro-tracheal intubation time ranged between 4-54 days (17 tracheotomies performed before oro-tracheal intubation). The results of this study showed that percutaneous techniques present fewer early post-operative complications (severe bleeding, erosive stomitis, dislocation of the cannula) and above all fewer sequelae in time (tracheal stenosis, tracheomalacia). The surgical procedures are shorter and nursing is limited to a few days which certainly results in a savings in health care resources. After decannulation, the esthetic result in patients that underwent the dilatational tracheotomy can be considered excellent. Among the disadvantages one must recall the possible dislocation of the cannula immediately after surgery: forced reinsertion of the cannula exposes the patient to the risk of creating a dangerous false route. The results obtained are statistically significant and in line with those found in the literature. The conclusion is drawn that, when performed by skilled surgeons and aided by endoscopy, the percutaneous tracheotomy techniques are the method of choice for patients in critical areas.