[Clinical application of modified percutaneous dilative tracheostomy in intensive care unit]

To investigate the application of modified percutaneous dilative tracheostomy (MPDT) in critical patients of intensive care unit (ICU).

The clinical data of 143 critically ill patients experienced tracheostomy in intensive care unit (ICU) of the Second Affiliated Hospital of Harbin Medical University were retrospectively analyzed. There were 55 cases in MPDT group, 41 in percutaneous dilative tracheostomy (PDT) group, and 47 in conventional surgical tracheostomy (ST) group. The operation information such as operation time, blood loss and the incidence of complications were observed among three groups.

The operation time (7.2 ± 1.9 minutes, 6.9 ± 2.1 minutes), amount of blood loss (6.9 ± 2.7 mL, 8.0 ± 3.2 mL), size of operative incision (1.2 ± 1.1 cm, 1.3 ± 0.9 cm) and incision healing time (7.5 ± 2.0 days, 6.7 ± 1.9 days) in MPDT group and PDT group were superior to ST group (23.1 ± 4.5 minutes, 26.3 ± 3.8 mL, 2.8 ± 1.2 cm, 10.1 ± 2.1 days, respectively) with statistical significances (all P<0.05) but there was no significant difference in above indexes between MPDT group and PDT group. The incidences of perioperative and postoperative complications in MPDT group and PDT group were significantly lower than those in ST group [perioperative period: 23.64% (13/55), 41.46% (17/41) vs. 55.32% (26/47); postoperative period: 18.18% (10/55), 31.71% (13/41) vs. 55.32% (26/47)] with statistical significances (all P<0.05). There was no tracheal wall injury or perforation and tracheoesophageal fistula in MPDT group, while there were 5 tracheal wall injuries, 5 perforations, and 5 tracheoesophageal fistulas in PDT group.

MPDT which is more effective, safe, simple and with minor injury than ST, is able to avoiding tracheal wall injury or perforation and tracheoesophageal fistula and is very suitable for patients in ICU.