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Percutaneous dilatational tracheostomy is as safe as open tracheostomy
Theodore M Khalili1, Wega Koss, Daniel R Margulies
1Burns and Allen Research Institute, Department of Surgery, Cedars-Sinai Medical Center, and the UCLA School of Medicine, Los Angeles, California 90048, USA.
The American Surgeon
|December 7, 2002
Summary
Percutaneous dilatational tracheostomy (PDT) and open tracheostomy (OT) have similar complication rates. The choice between PDT and open tracheostomy depends on surgeon expertise and patient factors.
Area of Science:
- Medical procedures
- Surgical techniques
- Patient safety
Background:
- Percutaneous dilatational tracheostomy (PDT) is an alternative to open tracheostomy (OT).
- Concerns exist regarding the relative safety of PDT compared to OT.
- Standardized protocols are crucial for performing PDT, especially in intensive care units (ICUs).
Purpose of the Study:
- To prospectively compare the safety and complication rates of PDT and OT.
- To evaluate the incidence of specific complications associated with each procedure.
- To provide evidence-based guidance on selecting between PDT and OT.
Main Methods:
- Prospective comparative study of 94 PDT and 252 OT procedures.
- Procedures performed between December 1998 and April 2000.
- Complications meticulously recorded, including bleeding, airway loss, hemodynamic instability, and tube malposition.
Main Results:
- Overall complication rates were comparable: 2.1% for PDT vs. 2.8% for OT (P=NS).
- Postoperative bleeding was the most common complication, occurring in 1 PDT and 4 OT patients.
- One PDT required conversion to OT due to tracheal fibrosis; other OT complications included emphysema and infection.
Conclusions:
- PDT and OT demonstrate comparable safety profiles and complication rates.
- Procedure selection should be individualized based on surgeon experience, patient condition, and anatomical factors.
- Both PDT and OT are viable options when performed under appropriate conditions and expertise.