Hybrid Tracheostomy: A Safe, Effective Compromise

Abstract

Objective: 1) Describe a minimally invasive hybrid tracheostomy technique that combines the advantages of open and percutaneous techniques. 2) Compare the safety of hybrid tracheostomy to a historical cohort of open tracheostomy. Method: We developed a rapid, efficacious technique of hybrid tracheostomy (HT), combining the advantages of standard (ST) and percutaneous (PT) techniques. This paper will review 173 patients, then describe the technique and present an outcome study and cohort comparison demonstrating the procedure’s efficacy. Results: HT uses a minimal approach similar to the percutaneous procedure but provides an open surgical view of the airway to ensure safety. It is significantly more rapid than PT, and bronchoscopy is not required. The typical procedure duration for resident surgeons performing HT ranges from 4 to 7 minutes. There were no intra-operative complications in the HT or ST groups. In a cohort of 15 cases matched for statistical assessment, there was no significant difference in postoperative bleeding, infection or accidental decannulation rates. There were no complications requiring operative intervention. Conclusion: HT appears to be more efficacious than either PT or ST. It provides the excellent airway control and visualization of ST, while being similarly or less invasive than PT. In our experience, there were no significant complications with either technique.