Percutaneous versus surgical tracheostomy: A randomized controlled study with long-term follow-up

William Silvester, Donna Goldsmith, Shige Uchino, Rinaldo Bellomo, Simon Knight, Siven Seevanayagam, Danny Brazzale, Marcus McMahon, Jon Buckmaster, Graeme K. Hart, Helen Opdam, Robert J. Pierce, Geoff A. Gutteridge

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160 Citations (Scopus)

Abstract

OBJECTIVE: To compare the safety, availability, and long-term sequelae of percutaneous vs. surgical tracheostomy. DESIGN: Prospective, randomized, controlled study. SETTING: Combined medical/surgical intensive care unit in a tertiary referral hospital. PATIENTS: Two hundred critically ill mechanically ventilated patients who required tracheostomy. INTERVENTIONS: Tracheostomy by either percutaneous tracheostomy or surgical tracheostomy performed in the intensive care unit. MEASUREMENTS AND MAIN RESULTS: The primary outcome measure was the aggregate incidence of predefined moderate or severe complications. The secondary outcome measures were the incidence of each of the components of the primary outcome. Long-term follow-up included clinical assessment, flow volume loops, and bronchoscopy. Both groups were well matched for age, gender, admission Acute Physiology and Chronic Health Evaluation II score, period of endotracheal intubation, reason for intubation, and admission diagnosis. There was no statistical difference between groups for the primary outcome. Bleeding requiring surgical intervention occurred in three percutaneous tracheostomy patients and in no surgical tracheostomy patient (p = .2). Postoperative infection (p = .044) and cosmetic sequelae (p = .08) were more common in surgical tracheostomy patients. There was a shorter delay from randomization to percutaneous tracheostomy vs. surgical tracheostomy (p = .006). Long-term follow-up revealed no complications in either group. CONCLUSIONS: Both percutaneous tracheostomies and surgical tracheostomies can be safely performed at the bedside by experienced, skilled practitioners.

Original languageEnglish
Pages (from-to)2145-2152
Number of pages8
JournalCritical Care Medicine
Volume34
Issue number8
DOIs
Publication statusPublished - 1 Aug 2006
Externally publishedYes

Keywords

  • Complications
  • Critical care
  • Follow-up
  • Mechanical ventilation
  • Percutaneous tracheostomy
  • Surgical tracheostomy

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