Our Experience with Percutaneous and Surgical Tracheotomy in Intubated Critically Ill Patients
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Date
2018
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Abstract
Objective: Open surgical tracheotomy (OST) andpercutaneous dilatational tracheotomy (PDT) arecommonly used for securing airway in intubated critically ill patients. The purpose of this study was tocompare the safety of OST and PDT, particularly inintubated critically ill patients.Methods: The medical records of intubated criticallyill patients who underwent tracheotomy between August 2006 and July 2017 were analyzed retrospectively.Minor and major complication rates were comparedaccording to the tracheotomy technique. Preoperativeintubation time, postoperative decannulation time, reason for hospitalization, and demographic data, including the Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ FailureAssessment (SOFA) scores, were evaluated.Results: A total of 332 cases were enrolled into thestudy. The minor and major complication rates for bothtechniques were 27.2%, 8.8%, 9.7% and 3.2%, respectively. Minor and major complication rates were higherin the OST group (p=0.01, p=0.03, respectively). Therate of every single complication was also compared ongroups’ basis. Accidental decannulation (p=0.02) andpneumothorax (p=0.05) were found to be significantlyfrequent in the OST group. There was no impact ofthe preoperative intubation time on the minor (p=0.20)and major complication (p=0.29) rates found. Therewas no statistically significant difference regarding thepostoperative decannulation time (p=0.32). Also, there was no statistically significant difference betweentwo groups in terms of the APACHE II (p=0.69) andSOFA (p=0.37) scores. However, a statistically significant difference between the groups in terms of overallsurvival was found, in favor of PDT (p<0.001).Conclusion: This study revealed that PDT is safer thanOST, particularly in intubated critically ill patients.