Percutaneous dilation tracheotomy versus surgical tracheotomy: our experience.

BACKGROUND: Percutaneous dilation tracheotomy (PDT) is becoming a popular alternative to surgical tracheotomy. In our department, we recently adopted the use of the PDT in intensive care unit patients. Here, we compare the results of the use of these 2 techniques on 150 patients, all performed by the same surgeon. We discuss the pros and cons of PDT and present our experience with the technique compared with surgical tracheotomy (ST).

MATERIALS AND METHODS: A prospective study of 75 PDTs and a retrospective study of 75 surgical tracheotomies (ST) were performed at the Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center, Haifa, Israel. Age, sex, duration of intubation before surgery, time interval between the decision to perform and the performance of tracheotomy, and cost were compared.

RESULTS: One hundred fifty tracheotomies were reviewed. The indication for tracheotomy in both groups was prolonged mechanical ventilation. Seven patients were found unsuitable for PDT and underwent ST. Complications included 3 cases of mild postoperative hemorrhage in the ST group, and 1 case of subcutaneous emphysema, 1 case of stomal cellulitis and 2 cases of mild postoperative hemorrhage in the PDT group. The average waiting interval was between 2 to 5 days for ST and 1 to 24 hours for PDT. The intraoperative time for ST was 20 minutes; for PDT, 5 minutes. The cost was 565 dollars for ST and 274 dollars for PDT.

CONCLUSIONS: PTD provides an easy, less expensive, and convenient alternative to ST and should be added to the otolaryngologists' armamentarium of surgical airway procedures. The procedure is advantageous for the patient. Complication rates of both techniques are similar and low; however, PDT is a blind technique of obtaining a surgical airway and therefore holds more potential for serious complications. It is our conclusion that this technique is suitable for many, but not all, critical care patients and that the procedure should be performed only by surgeons who are capable of urgently obtaining a surgical airway or exploring the neck should the PDT fail.