A comparative study of open tracheostomy and percutaneous tracheostomy in ICU setting

Abstract

Background: The standard tracheostomy involves open standard dissection technique, established more than a hundred years ago. Alternative procedures like percutaneous tracheostomy (PCT) have evolved recently due to advance in technology and interest in minimally invasive procedures. A systematic randomized comparative cohort study was done with the aim to compare standard open tracheostomy with percutaneous tracheostomy techniques, namely serial guide wire dilating forceps (GWDF) and PercuTwist. Methods: This study was carried out in the Department of ENT and head and neck surgery in a tertiary referral medical center of Indian Army. The patients were followed up for one year post-decannulation or till their death due to medical morbidities. 45 adult patients in ICU, intubated and on prolonged mechanical ventilation, needing elective tracheostomy were included in the study. Pediatric cases, patients with distorted neck anatomy and those requiring emergency tracheostomy were excluded. 15 patients underwent standard open surgical tracheostomy. Amongst the other 30 cases, 15 percutaneous tracheostomy were done by guide wire dilating forceps technique and remaining 15 by PercuTwist. Results: Although the indications were limited and another surgeon was required to keep a watch through bronchoscope, it was observed that PCT was easier and quicker than open standard tracheostomy. It involved small incision and no dissection, less tissue trauma and better cosmetic result. Comparatively, the complication rate was also less. Conclusion: It can be concluded that training of surgeons and proper case selection makes percutaneous tracheostomy as good and safe as open technique.