[Tracheotomy: discussion of various surgical procedures using argon plasma coagulation]

E Klemm
Laryngo- Rhino- Otologie 1999, 78 (2): 86-90

BACKGROUND: At present there is a discernible lack of consensus among different medical specialties regarding methods of tracheotomy in an intensive care setting. There is an obvious preference for percutaneous dilatational tracheotomy methods. Comparison of different methods are necessary to determine whether this trend is justified.

METHOD: ENT and intensive care departments together performed 270 tracheotomies using different techniques in longtime-intubated adults over a period of 4 years. Severe complications were compared. Twenty conventional surgical tracheotomies were performed by using argon-plasma coagulation (APC).

RESULTS: Comparison of 2175 percutaneous and 3263 conventional surgical tracheotomies reveals a nearly identical rate of severe perioperative complications. Percutaneous methods are most frequently used in patients with initially uncomplicated conditions.

CONCLUSIONS: On the basis of our experience with 270 tracheotomies we have found there are clear indications for the various methods of tracheotomy. They depend on both the history of the disorder and its course and on the known contraindications to percutaneous tracheotomy methods. For safety reasons, we do not perform percutaneous tracheotomies on patients with severe brain damage who tend to aspirate and require prolonged neurological rehabilitation. Preoperative bleeding in percutaneous tracheostomies is the most important complication. It led to a life-threatening situation in 2.4% of our cases. Preoperative neck ultrasound may decrease the risks due to unusual anatomical conditions. Comparison of significant perioperative complications does not appear to favor any one method at present. In light of our effective cooperation with other specialties in planning and performing tracheotomies we do not feel that the current general preference for percutaneous methods in intensive care medicine is justified. Initial experience with APC shows promising results concerning its use in conventional tracheotomies. However, we noticed a shorter operation time, reduction of bleeding complications, and use of less suture material. The effectiveness of surgical intervention is improved by a number of factors.

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