Percutaneous tracheostomy, making it easier

Abstract

Abstract Objective Open and percutaneous tracheotomy (PT) lead to many perioperative complications. To minimize the complication and to save time and cost, certain assistive tools can be used like fiberoptic bronchoscope, ultrasound guidance and others. Aim The aim was to compare the three procedures, blind PT, fiberoptic bronchoscopy-guided PT and open tracheostomy, regarding ease of the technique, infection rate, bleeding, and complications of the procedure. Design A retrospective comparative trial was conducted. Setting ICU at Dar El Shefa Hospital and respiratory ICU, Ain Shams University Hospital, were the locations for study conduction. Patients and methods All patients required prolonged mechanical ventilation during period between August 2012 and August 2014. They were assigned into three groups: group I underwent open tracheostomy and included 16 patients, group II underwent blind PT and included 15 patients, and group III underwent fiberoptic-guided PT and included 12 patients. Results A total of 43 patients underwent tracheostomy during the study period. There was a statistically significant difference between the studied groups regarding neck circumference and intubation period before tracheostomy. Regarding hemodynamics, there is no statistically significant difference regarding mean heart rate, mean arterial pressure and FiO2, pH, PaO2, PCaO2, PaO2/FiO2 and oxygen saturation SPO2 before and after each procedure. Regarding complications after procedure, it shows that blind group had higher percentage of patients with no complications (86.7%) followed by fiberoptic group (75%) and open tracheostomy group (50%). It was noticed that the lowest mean of duration of the procedure was found in the blind group (15.7±5.3), followed by fiberoptic group (17.8±3.2) and lastly the open tracheostomy group (25.7±6.3). Conclusion This study showed that PT had fewer complications than open tracheostomy, saved operating room resources as well as was more cost effective.