Percutaneous versus surgical bedside tracheostomy in the intensive care unit: a cohort study

To compare the outcomes, as well as the short and long term complications, of percutaneous dilational tracheostomy (PDT) and surgical tracheostomy (ST) at the bedside.

From 2003 to 2005, 367 consecutive patients underwent percutaneous tracheostomy in two general ICUs of a community hospital. Short and long term complications, procedural time, duration on mechanical ventilation, length of stay in the ICU and in the hospital, and mortality rates were compared to a historical cohort of 161 patients treated with surgical tracheostomy. Both groups were comparable in demographic characteristics and severity scores.

As a whole, 528 mechanically ventilated patients underwent tracheostomy at the bedside. 161 patients received ST and 367 PDT by the single dilator technique. Only minor complications were observed in both groups of patients. PDT was performed more rapidly than ST (5.4+/-5.2 vs 19+/-10 min). STs were performed significantly later than PDT (12.4+/-6 days vs 8.7+/-5.8 days, P<0.05). The overall ICU stay and mean duration of mechanical ventilation were lower in the PDT than in the ST group (18.4+/-13.9 vs 23.3+/-15.8 days, P< 0.05 and 14.2+/-8.1 vs 20.1+/-10.4, P<0.05, respectively). There were no statistically significance differences in ICU and hospital outcome between the two techniques.

Compared with ST, the main advantage of PDT is that it is more rapid and allows the tracheostomy to be performed earlier in the course of ventilatory failure. Early tracheostomy is associated with a shorter duration of mechanical ventilation and a reduced ICU length of stay.