University of Istanbul, Medical Faculty of Istanbul, Anesthesiology and Intensive Care Department, Istanbul, Turkey
Introduction
Since the first report of dilatational percutaneous tracheostomy (PDT) many favorable reports have been published which accepted this technique as a safe alternative to surgical tracheostomy. In this study we want to evaluate two different kinds of techniques' advantages and complications.
Methods
We evaluated 90 patients who tracheostomized with PDT, 45 of them with dilating forceps technique (DFT) (SIMS Portex Kent, UK) and 45 of them with multi dilatational technique (MDT) (Cook Critical Care Systems Bloomington, USA). Indications were prolonged ventilator dependence, facilitation of weaning from mechanical ventilation, and prolonged coma. Prior to clinical application, informed consent from the patient or next of kin was obtained in all cases. The PDT procedure was chosen randomly. All patients were in routine ICU monitoring (ECG, SpO2, invasive arterial monitoring). Two techniques were performed as previously described
Results
We observed one tracheoeosephageal fistula, but it did not necessitate surgical repair, besides one peristomal infection, cuff rupture and late bleeding (in 5th day) in DFT group. Stomal fistula seen after decanulation in MDT group, peristomal infection and bleeding were also observed. Other demographic data are in the Table.
Age (years)
APACHE II
Day of performing PT
ICU stay (days)
Duration of PT (minutes)
Complication rate
DFT
MDT
DFT
MDT
DFT
MDT
DFT
MDT
DFT
MDT
DFT
MDT
52 ± 20.2
46.6 ± 21.8
14.8 ± 7.6
13.1 ± 5
10.9 ± 6.4
8.5 ± 6.8
45.4 ± 30.8
39.6 ± 24.1
4.5 ± 2.5
7.2 ± 3.5
12%
10.3%
Conclusion
We have not seen any mortality due to PT in our cases and there were no differences in complication rates and other data except duration of PT. Tracheoeosephageal fistula is seen in DFT, however we need larger patient series to decide exactly which technique will be safer.