Comparison of the effects of different percutaneous tracheotomy techniques on acute tracheal trauma

Abstract

As it can easily be performed at the bedside with minimal morbidity, percutaneous dilatational tracheotomy (PDT) is preferred over surgical tracheotomy. The aim of this study is to compare the effects of different PDT techniques on posterior tracheal wall injury. The study was conducted at the Gazi University Laparoscopy Training Center after approval was granted by the ethics committee. After sedation with xylazine/ketamine, electrocardiography, peripheral oxygen saturation, and blood pressure were monitored. Propofol was used to achieve the desired level of sedation during the procedure. There were 16 pigs, randomly allocated into 4 groups. Multiple, single, forceps, and twist dilator techniques were performed in groups I, II, III, and IV, respectively. At the end of the course all pigs were sacrificed and tracheas were harvested for macroscopic and histopathological evaluation. Macroscopic evaluation revealed erythematous/hemorrhagic and ulcerative lesions on the posterior wall of all samples. Histopathological injury was observed in all samples and was similar in all groups. Procedural time was significantly longer in group I than in all other groups (P < 0.05). Although the results are conflicting, bronchoscopy-aided PDT is believed to reduce complications. In our study, PDTs were performed without bronchoscopy, and posterior wall injury was observed in all samples. Therefore, we suggest using bronchoscopy to reduce procedure-related complications and improve patient safety during PDT.