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Percutaneous dilation tracheotomy versus surgical tracheotomy: our experience
David Goldenberg1, Avishay Golz, Antoinette Huri
1Department of Otolaryngology-Head and Neck Surgery and Neurosurgical Care Unit, Rambam Medical Center and Technion Faculty of Medicine, Haifa, Israel. gdavid@tx.technion.ac.il
Summary
Percutaneous dilation tracheotomy (PDT) is a cost-effective and faster alternative to surgical tracheotomy (ST) for intensive care unit patients. While PDT offers significant advantages, careful patient selection is crucial due to its potential for serious complications.
Area of Science:
- Otolaryngology
- Surgical Airway Procedures
- Intensive Care Medicine
Background:
- Percutaneous dilation tracheotomy (PDT) is increasingly utilized as an alternative to traditional surgical tracheotomy (ST).
- This study evaluates the adoption of PDT in an intensive care unit setting.
- A direct comparison between PDT and ST was conducted by a single surgeon.
Purpose of the Study:
- To compare the efficacy, safety, and cost-effectiveness of PDT versus ST.
- To analyze the outcomes of PDT in critically ill patients requiring tracheotomy.
- To discuss the advantages and disadvantages of PDT in clinical practice.
Main Methods:
- A prospective study of 75 PDTs and a retrospective review of 75 STs were performed.
- Patient data including age, sex, duration of intubation, and time to procedure were compared.
- Complications, intraoperative time, and costs associated with each technique were analyzed.
Main Results:
- PDT demonstrated significantly shorter waiting intervals (1-24 hours) compared to ST (2-5 days).
- Intraoperative time for PDT (5 minutes) was substantially less than for ST (20 minutes).
- PDT was more cost-effective ($274) than ST ($565), with similar low complication rates, although 7 patients were unsuitable for PDT.
Conclusions:
- PDT is a valuable, less expensive, and convenient addition to the surgical airway procedures available to otolaryngologists.
- While complication rates are comparable and low, PDT's blind nature necessitates careful patient selection and surgeon expertise.
- The procedure is suitable for many critical care patients but requires surgeons capable of managing potential complications or performing emergent surgical airways.