Dilatational Percutaneous vs Surgical TracheoStomy in IntEnsive Care UniT: A Practice Pattern Observational...

Area of Science:

• Critical Care Medicine
• Surgical Procedures
• Intensive Care Unit Management

Background:

• Tracheostomy is a common ICU procedure, with percutaneous dilatational tracheostomy (PDT) often being the preferred method.
• Understanding current tracheostomy practices in Indian ICUs is crucial for optimizing patient care.

Purpose of the Study:

• To investigate the current practices and outcomes of tracheostomy in Indian intensive care units.
• To compare percutaneous dilatational tracheostomy (PDT) with surgical tracheostomy (ST) in terms of techniques, complications, and cost.

Main Methods:

• A pan-India, multicenter, prospective observational study was conducted from September 2019 to December 2019.
• Data on 923 tracheostomies (666 PDT, 257 ST) were collected and statistically analyzed using SPSS.
• The study involved 67 participating ICUs, predominantly from private sector hospitals.

Main Results:

• PDT, particularly the single dilator technique, was the preferred method (60.4%) and was often performed by intensivists (74.2%).
• PDT demonstrated significantly lower rates of hemorrhagic (2.6% vs 7%) and desaturation complications (2.3% vs 6.6%) compared to ST.
• PDT procedures were shorter, resulted in more ventilator-free days, and were approximately Rs. 13,104 cheaper per patient than ST.

Conclusions:

• Percutaneous dilatational tracheostomy, especially the single dilator technique, is favored in Indian ICUs.
• PDT is associated with fewer complications and reduced costs compared to surgical tracheostomy.
• Intensivists are increasingly performing PDT, indicating a shift in practice patterns.