[Percutaneous tracheotomy and cricothyroidotomy in the critical patient]

To review and compare the complications of percutaneous tracheotomy (TP) and cricothyroidotomy (CT) used to perform tracheal intubation in patients requiring prolonged mechanical ventilation.

A prospective, observational study performed from October 2004 to October 2006, and follow-up of course until May 2007.

Intensive care service from a university-affiliated teaching hospital.

A total of 82 patients in which CT or TP were necessary. Forty-three TP and 39 CT were performed.

Reason for TP or CT, demographic data, severity scores, ICU length of stay, orotracheal intubation (OTI) days, CT/TP early and late complications and in-hospital evolution were collected.

TP/CT were performed due to prolonged ventilation in 62 (76%) patients and because of impaired neurological status in the remaining patients. There were no differences between TP/CT in gender, APACHE II, ICU length of stay, previous OTI days. Patients in the CT group were older (68 +/- 9 vs 54 +/- 15 years, p < 0.001). There were 5 mild adverse events (3 guide angulations and 2 lateral tracheal punctions) after TP, and 1 severe adverse event (pulmonary ventilation problem) after CT. There were no fatal event related with TP/CT. Thirty-four patients were decanulated. Mild local injuries were seen in 8 patients (6 TP vs 2 CT). Only 1 subglottic granuloma was seen late in CT group.

In our experience CT constitutes a safety and feasible alternative to TP when TP is counter-indicated.