Percutaneous versus surgical tracheostomy: A randomized controlled study with long-term follow-up

Area of Science:

• Critical Care Medicine
• Surgical Procedures
• Respiratory Care

Background:

• Tracheostomy is a common procedure for critically ill patients requiring prolonged mechanical ventilation.
• Both percutaneous and surgical techniques are utilized, with varying safety profiles and outcomes.
• Understanding long-term sequelae is crucial for patient management.

Purpose of the Study:

• To compare the safety, availability, and long-term sequelae of percutaneous tracheostomy versus surgical tracheostomy.
• To evaluate complication rates and functional outcomes following each procedure.

Main Methods:

• Prospective, randomized, controlled study involving 200 mechanically ventilated patients.
• Tracheostomy performed via either percutaneous or surgical technique in the intensive care unit.
• Outcomes assessed included aggregate complications, specific adverse events, and long-term clinical and functional assessments.

Main Results:

• No significant difference in the primary outcome of moderate or severe complications between percutaneous and surgical tracheostomy groups.
• Surgical tracheostomy group showed higher rates of postoperative infection (p = .044) and cosmetic sequelae (p = .08).
• Percutaneous tracheostomy demonstrated a shorter delay from randomization to procedure (p = .006); no long-term complications were observed in either group.

Conclusions:

• Both percutaneous and surgical tracheostomies are safe and effective when performed by experienced practitioners.
• Percutaneous tracheostomy may offer advantages in reduced procedural delay and potentially fewer infectious and cosmetic complications.
• Long-term follow-up indicates no significant adverse sequelae for either method.