Percutaneous Tracheostomy Group Research Articles

Outcomes of percutaneous versus surgical tracheostomy in an Australian Quaternary Intensive Care Unit: An entropy-balanced retrospective study

Background: Studies comparing percutaneous tracheostomy (PT) and surgical tracheostomy (ST) complications in the critically ill patient population with high acuity, complexity, and severity of illness are sparse. This study evaluated the outcomes of elective PT versus ST in such patients managed at a quaternary referral center. Aims: The primary aim was to detect a difference in hospital mortality between the two techniques. The secondary aims were to compare Intensive Care Unit (ICU) mortality, complications (including stoma site, tracheostomy-related, and decannulation complications), ICU and hospital length of stay, and time to decannulation. Methods: This was a single-center retrospective observational study of ICU admission from August 2018 to August 2021. Patients were included if an elective tracheostomy was performed during their ICU admission. Patients with a pre-existing tracheostomy and those who underwent an obligatory tracheostomy requirement (e.g. total laryngectomy) were excluded. Cohorts were matched using Hainmueller’s entropy balancing. Binary data were evaluated using logistic regression and continuous data with ordinary least squares regression. Results: 349 patients with a tracheostomy were managed in the ICU during the observation period. They were predominantly males (75% in PT; 67% in ST), with a mean age in the PT and ST group of (47; SD = 18) and (55; SD = 16), respectively. After exclusion, 135 patients remained, with 63 in the PT group and 72 in the ST group. Patients receiving ST were significantly older with a higher Body Mass Index (BMI) than the PT group. There were no significant differences in gender, Acute Physiological And Chronic Health Evaluation (APACHE) III, and the Australian and New Zealand Risk Of Death (ANZROD) between the two groups. There was no difference in hospital mortality between groups (OR 0.91, CI 0.26–3.18, p = 0.88). There were also no differences in ICU mortality, ICU and hospital length of stay, and time to decannulation. PT was associated with a greater likelihood of complications (OR 4.19; 95% CI 1.73–10.13; p < 0.01). PT was associated with a greater risk of complications in those who had this performed early (<10 days of intubation) as well as late (>10 days of intubation). Conclusions: Percutaneous tracheostomy was associated with higher complications compared to surgical tracheostomy. They were related to tracheostomy cuff deflation, stomal site bleeding and infection, sputum plugging, and accidental and failed decannulation. These findings have identified opportunities to improve patient outcomes.

Tracheostomy Outcomes on Trauma Patients.

Tracheostomies are performed in trauma patients for multiple purposes. Approaches to the procedure are usually directed by individual expertise and local preferences. Though generally safe, a tracheostomy can cause serious complications. This study aims to identify complications associated with tracheostomies performed at the level I Trauma Center of the Puerto Rico Medical Center (PRMC) to have an advanced foundation to develop and implement guidelines to improve patient outcomes. A retrospective cross-sectional study. Level I Trauma Center of the PRMC. Medical charts of 113 trauma adult patients that underwent tracheostomy at the PRMC from 2018 to 2020 were reviewed. Data collected included patient demographics, surgical approach, initial tracheostomy tube size (ITTS), intubation period, and flexible laryngoscopic findings. Complications occurring during and after tracheostomy were documented. The unadjusted relationship of the independent variables and outcome measures was assessed using χ 2and Fisher's test for categorical variables and the Wilcoxon-Mann-Whitney rank-sum test for continuous ones. Abnormal airway findings detected on flexible laryngoscopic examination were reported in 30 patients in the open tracheostomy (OT) group and 43 patients in the percutaneous tracheostomy group (p = 0.007). Peristomal granulation tissue was reported in 10 patients with an ITTS 8, while in only 1 patient with an ITTS 6 (p = 0.026). This study showed several key findings in our cohort. The OT surgical approach was associated with fewer long-term complications when compared to the percutaneous approach. Also, a statistically significant difference in peristomal granulation tissue findings was found between the ITTS,ITTS-6 and ITTS-8, the smaller size being associated with fewer abnormal findings.

Yoğun Bakım Ünitemizde Perkütan Yöntemle Açılan Trakeostomi Deneyimlerimiz; Retrospektif Analiz

Background: To retrospectively evaluate 58 patients who underwent percutaneous tracheostomy in our intensive care unit.Materials and Methods: The study included 58 patients that underwent percutaneous tracheostomy in the ICU at our Anesthesiology and Reanimation department between January 2017 and December 2020.Results: The percutaneous tracheostomy group comprised 33 (56.9%) men and 25 (43.1%) women with a mean age of 65±18.2 (range, 19-90) years. Most common primary diagnosis of hospitalization was neurological disorders (51.7%). Mean APACHE II score was 23.2±3.6, mean time to percutaneous tracheostomy was 18.3±5.1 (range, 7-30) days, mean procedural time was 11.1±2.4 min, mean duration of mechanical ventilation was 62.1±37.8 (range, 15-167) days, mean intensive care unit stay was 67.2±43.5 (range, 15-247) days, and mean hospitalization time was 77.5±50.4 (range, 15-277) days. Hypoxia and hypotension were the most common intraoperative complications and minor bleeding was the most common postoperative complication.Conclusions: Performing early tracheostomy in intensive care unit patients requiring prolonged mechanical ventilation increases patient comfort, facilitates discontinuation of mechanical ventilation, reduces the dead space, facilitates the clearing of airway secretions, and shortens the duration of intensive care unit and hospital stay. Additionally, percutaneous tracheostomy was revealed as a safe procedure for intensive care unit patients due to its lower complication rates.

Tracheostomy: Open Surgical or Percutaneous? An Effort to Solve the Continued Dilemma.

Due to lack of globally standardized guidelines and clarity on indications, patient selection, intra-operative preparations, technique, complications, postoperative care and decannulation protocols, percutaneous tracheostomy (PT) has come in vogue as compared to standard open surgical tracheostomy (OST). PercuTwist and guide wire dilatational method (GWDF), techniques of PT, offer lesser operative time and ease of surgery being a bedside procedure. There seems to be paucity of Indian literature on rising trend of increasing indications, post-operative care, management of complications and outcomes of tracheostomy. And thus, there arises a felt need to envisage a study in tertiary care setup targeting these issues and to question the so far unchallenged acceptance of new techniques and technology.Our aim is to study the recent trend of indications, complications, and outcomes of both OST and PT in a cohort of Indian patients who underwent tracheostomy. 80 patients with mean age of 59.0 ± 15years underwent tracheostomy (OST: 48 (60%), PT: 32 (40%), and among PT, PercuTwist: 16 (50%), GWDF: 16 (50%)) for various indications with objectives to compare operative time, complications and decannulation rates of tracheostomy surgery, within the follow up period of 3months. Most common indication of elective tracheostomy was prolonged ventilation, and for emergency ones, upper airway obstruction. Mean operative time taken by all the three techniques was comparable, i.e., 16.3 v/s 15 v/s 15.3min (Open v/s PT GWDF v/s PT PercuTwist). Most common intra-operative complication of OST was haemorrhage (16.3%) and that of PT was false passage (8.8%). Early post-operative complications were haemorrhage (OST: 3.75%, PT: 1.25%) and tube blockage and dislodgement (equal distribution among OST and PT). Late post-operative complications were stomal granulations in PT: 7.5%. Outcomes of tracheostomy were significantly better with OST (36 (45%)) than PT (14 (17.5%)). In PT group, PercuTwist fared better than GWDF in terms of lesser complications (PercuTwist: 10%, GWDF: 18.6%) and better decannulation rates (PercuTwist: 13.6%, GWDF: 3.75%). Most common indication for tracheostomy remains prolonged intubation; complication of OST is intra and early post-operative haemorrhage and that of PT being tube dislodgement and blockage. Outcomes in form of successful decannulation are with OST.

DOZ047.86: Open tracheostomy vs percutaneous tracheostomy in pediatrics

Abstract Introduction Tracheostomy is one of the most frequent surgical procedures in chronically ill pediatric patients and mechanical ventilatory assistance. The most widely used technique is open; however, the percutaneous technique guided by endoscopy is becoming increasingly common. Due to the current controversy, this study presents our experience in both techniques. Methodology Retrospective and descriptive analysis was carried out of 100 patients selected between 2010 and 2017. They were divided into two groups: open tracheostomy (TA) and percutaneous tracheostomy (PT), with 50 patients each according to the technique used. The age, diagnosis, indication of tracheostomy, days of intubation, endoscopic findings, cannula size, surgical time, intraoperative complications, and definitive decannulation were analyzed. A bibliographic review was also carried out. Results and Discussion The main indication for tracheostomy in both groups was prolonged orotracheal intubation (TA group 78% and TP group 82%). Children who underwent percutaneous tracheostomy were older in age (median age of 9 years for TA group and 2.5 years for PT group). There were no significant differences regarding the days of previous intubation: 19 days for the TA group and 13 days for the TP group. Weaning was achieved before mechanical ventilation for the TP group (7 days in the TP group and 19 days in the TA group). The surgical time was almost 50% less for the TP group (TA group 80 minutes and TP group 45 minutes). There were no intraoperative complications in any group. Distant complications were more frequent in the TA group (34%). Definitive decannulation was achieved in 17 patients in the TA group (34%) and in 19 patients in the TP group (38%). The long-term follow-up was performed for 8 months by the TA group (r: 1–36 m) and 9 months by the TP group (r: 1–48 m). Conclusions Percutaneous tracheostomy is feasible in children. Simultaneous endoscopic vision is recommended for the control of complications during the procedure. At the same time it allows us to diagnose preexisting injuries. The size of the tracheostomy kit should be adjusted to the age of the patient and the size of the tracheostomy cannula to perform a safe tracheostomy.

Comparison of Percutaneous Dilatational Tracheostomy with Open Tracheostomy in Intensive Care Unit

Introduction: Tracheostomy is one of the frequent surgical procedure carried out in intensive care unit. Percutaneous tracheostomy is becoming increasingly popular compared to conventional open surgical tracheostomy in ICU.
 Methods: A prospective randomized trial with twenty patients in each group was conducted to compare the outcomes of percutaneous and surgical tracheostomy. Percutaneous tracheostomy was performed using Ciaglia Blue Rhino technique and surgical tracheostomy was performed using established technique. The outcomes were compared in relation to randomization to tracheostomy, completion of procedure, intra operative and post-operative complications, hospital length of stay and cost.
 Results: There were no major complications in either group. Most variables studied were not statistically significant. The two groups did not differ in terms of basic demographics or APACHE II score. The only variables to reach statistical significance were time duration from tracheostomy randomization to start of procedure and time taken for completion of procedure. It was mean 31.85±15.35 hours in Percutaneous Tracheostomy group and in Surgical Tracheostomy group it was mean 49.10±23.61 hours respectively (p<0.009). Time taken to perform percutaneous tracheostomy was mean 15.50±3.22 minutes and for surgical tracheostomy it was mean 20.30±3.38 minutes. (p<0.001).
 Conclusion: Percutaneous dilatational tracheostomy is simple, faster to perform and can be done at bedside to avoid considerable delay in the performance of open tracheostomy where there is high demand for elective and emergency procedures in operating room.

Incidence of sternal wound infection after tracheostomy in patients undergoing cardiac surgery: A systematic review and meta-analysis

PurposeThis systematic review and meta-analysis was performed to determine whether timing or type of tracheostomy was associated with superficial or deep sternal wound infections after cardiac surgery. MethodsAll studies reporting the incidence of sternal wound infection after tracheostomy in patients undergoing cardiac surgery were collected and analyzed. Subgroup analyses determined a priori included timing of tracheostomy and type of procedure (open vs percutaneous). All analyses used the random effects model. A meta-regression analysis was performed on the proportion of sternal wound infection and number of days between tracheostomy and initial cardiac surgery. ResultsA total of 13 studies met inclusion criteria. The incidence of sternal wound infection across all studies reported was 7% (95% confidence interval [CI], 4-10). The percutaneous tracheostomy group had a sternal wound infection proportion of 3% (95% CI, 1-8), and the open tracheostomy group had a sternal wound infection proportion of 9% (95% CI, 5-14). The incidence of sternal wound infection with early (<14 days) (7%; 95% CI, 3-11) versus late (≥14 days) (7%; 95% CI, 4-10) tracheostomy was similar. Meta-regression demonstrated no significant relationship between incidence of sternal wound infection and number of days between tracheostomy and initial cardiac surgery (R2 = 6.13%, P = .72). Reported secondary outcomes included 30-day and 1-year mortality, which were high at 23% (95% CI, 19-28) and 63% (95% CI, 43-80), respectively. ConclusionsThe incidence of sternal wound infection after tracheostomy in patients undergoing cardiac surgery remains high at 7% (95% CI, 4-10). Open or percutaneous tracheostomy after cardiac surgery is a feasible option because the incidence of sternal wound infection and short-term mortality are comparable. Moreover, the timing of tracheostomy (early or late) had comparable rates of sternal wound infection and short-term mortality.

The application of a small incision combined with improved percutaneous tracheostomy in difficult tracheostomy

To describe an improved percutaneous tracheostomy combined with conventional tracheostomy technique with result of less trauma and fewer complications, and to explore its application in the patients for whom conventional tracheostomy is difficult to perform. A prospective study was conducted. Fifty-seven hospitalized patients, in whom ordinal tracheostomy was difficult to perform, and admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Bengbu Medical College from January 2013 to December 2014 were enrolled. According to the random digital table method, the patients were divided into small incision combined with percutaneous tracheostomy group (small puncture incision group, n = 25) and conventional tracheostomy group (n = 32). Amount of blood loss, postoperative bleeding, incision size, operation time and wound healing time were compared between the groups. Compared with traditional surgical tracheostomy group, the blood loss and postoperative bleeding were decreased [blood loss (mL): 11.36 ± 4.25 vs. 23.72 ± 7.29, t = -7.201, P = 0.000; postoperative bleeding (mL): 11.60 ± 6.57 vs. 26.77 ± 10.77, t = -5.834, P = 0.000 ], incision size was smaller (cm: 2.20 ± 0.63 vs. 4.06 ± 1.19, t = -6.806, P = 0.000), and operation time and wound healing time were shortened [operative time (minutes): 18.16 3.61 vs. 29.09 ± 6.77, t = -7.001, P = 0.000; incision healing time (days): 4.96 ± 1.59 vs. 7.19 ± 2.35, t = -3.975, P = 0.000] in small puncture incision group. Compared with the traditional method, small incision puncture tracheostomy is less time consuming, with fewer traumas, and fewer intraoperative and postoperative complications.

Incidence of overall complications and symptomatic tracheal stenosis is equivalent following open and percutaneous tracheostomy in the trauma patient

BackgroundWhile percutaneous tracheostomy (PT) is becoming the procedure of choice for elective tracheostomy, there is little late complication data. This study compared incidence of, and factors contributing to, tracheal stenosis following PT or open tracheostomy (OT). MethodsA 10-year review was conducted of trauma patients undergoing tracheostomy. Data on demographics, injury severity, tracheostomy type, complications, and outcomes were compared between patients receiving PT or OT and for those with or without tracheal stenosis. ResultsOf 616 patients, 265 underwent OT and 351 underwent PT. Median injury severity score was higher for PT (26 vs 24, P = .010). Overall complication rate was not different (PT = 2.3% vs OT = 2.6%, P = .773). There were 9 tracheal stenosis, 4 (1.1%) from the PT group and 5 (1.9%) from the OT group (P = .509). Mortality was higher in OT patients (15.5% vs 9.7%, P = .030). Patients developing tracheal stenosis were younger (29.8 vs 45.2 years, P = .021) and had a longer intensive care unit length of stay (28.3 vs 18.9 days, P = .036). ConclusionRisk of tracheal stenosis should not impact the decision to perform an OT or PT.

Does submental intubation technique show an edge over percutaneous tracheostomy? A prospective study in complex oromaxillofacial surgery

Background: Complex oromaxillofacial fractures pose unique challenge for securing the airway. Techniques other than conventional tracheostomy and orotracheal intubation need to be explored to overcome shortcomings associated with conventional methods. This study compares median approach of submental intubation with percutaneous tracheostomy with respect to procedure time, time for extubation/decannulation, length of stay in intensive care unit and complications encountered. Aims: To evaluate procedure time, time for extubation/decannulation, length of stay in intensive care unit and complications for two techniques of airway management in oromaxillofacial surgeries.Settings and Design: Institutional, prospective study.Materials and methods: This prospective study included 25 patients who sustained oromaxillofacial fracture operated under general anesthesia from August 2008 to December 2009. In 15 patients, submental intubation and in 10 patients percutaneous tracheostomy technique were adopted. Complex oromaxillofacial fractures included Lefort 1 and 2, nose, ethmoid and orbit, maxilla and mandible. Airway technique of submental intubation and percutaneous tracheostomy were attempted on the basis of interincisor gap. The procedure time for the two techniques, the time for extubation/decannulation and the length of stay in intensive care unit were evaluated statistically.Statistical analysis used: unpaired ‘t’ test. Results: Of the 25 patients, there were 12 males, 3 females and 8 males,2 females in the submental intubation and percutaneous tracheostomy group respectively. All patients belonged to ASA status 1 and 2. The first successful attempt achieved for submental intubation group and percutaneous tracheostomy group was 93% and 90% respectively. The mean time to perform the submental intubation procedure was 5.27 + 0.72(mean + standard deviation) minutes and 21.72 + 2.04 minutes for percutaneous tracheostomy group. The mean time for extubation was 4.73 + 8.18 days in submental intubation group and 23.3 + 5.25 days for decanulation in percutaneous tracheostomy group. The average length of stay in intensive care unit postoperatively were 6.73 + 8.18 days in submental intubation group and 25.8 + 6.81 days for percutaneous tracheostomy group. Theperformance time, the time for extubation/decannulation and the length of stay in intensive care unit were statistically highly significant for the two groups. Complications encountered in the two groups were recorded. Conclusions: Both, submental intubation and percutaneous tracheostomy can secure the airway in complex oromaxillofacial fracture reduction surgery. Both techniques allow uninterrupted surgical access to the operative field. Although submental intubation technique gives an imperceptible scar which has aesthetically greater acceptance compared to functionally challenging and unsightly tracheostoma which pose an enormous stress to the patient. The complications associated with tracheostomy are at times difficult to manage even in expert hands. Though submental intubation is easily performed, the selection of a particular technique should take into consideration factors other than preoperative airway assessment.

Percutaneous versus Conventional Tracheostomy in Burned Patients with Inhalation Injury

The aim of the study was to compare conventional tracheostomy with percutaneous dilatational tracheostomy in patients with inhalation burn injury. A total of 37 patients with severe burn injuries and associated inhalation injury, underwent percutaneous tracheostomy in our burn unit and were retrospectively compared with 22 patients who underwent conventional surgical tracheostomy. In the first group, 25 of 37 patients and in the second group 17 of 22 patients presented with partial or full-thickness burn injuries (or both) in the neck region. The cost of the procedure, operating time, complications, and incidence of pulmonary infection were recorded. There were no significant perioperative complications in the percutaneous tracheostomy group, and no patient required surgical revision or conversion to surgical tracheostomy. In the conventional tracheostomy group, 2 patients developed tracheal stenosis, 1 had a tracheoesophageal fistula, and 10 had stomal infections. The average procedure time in the first group was 9 minutes, and in the second group it was 22 minutes. The cost of the bedside percutaneous tracheostomy was one-fifth the cost of a conventional tracheostomy. The incidence of pulmonary sepsis was 45% after percutaneous tracheostomy compared to 68% after conventional tracheostomy. With the percutaneous technique, spontaneous closure of the stoma occurred within 1 to 3 days after removal of the tracheostomy tube, whereas with the conventional technique it was within 5 to 7 days. Percutaneous tracheostomy is associated with a lower complication rate and can be safely performed at the bedside. Moreover, it is faster and can be done at a lower cost than conventional open tracheostomy.

Percutaneous tracheostomy: one center’s experience with a new modality

Background A retrospective review of our experience with percutaneous tracheostomy was performed to determine our complication rate and pattern of use since this modality was introduced at our institution. Methods A retrospective chart review captured all patients in whom tracheostomy was performed or supervised by a trauma/critical care faculty member. Dates of hospital admission, ICU admission, intubation, discontinuation of mechanical ventilation, type and location of procedure, procedural complications, Injury Severity Score, charges, and patient demographics were collected. Percutaneous tracheostomy (PT) and open tracheostomy (OT) experiences were compared. Results Three hundred sixty-eight tracheostomies were performed (190 OT and 178 PT). The average time to tracheostomy (TTT) for PT patients decreased from 12.7 to 7.4 days. The average TTT for OT patients remained stable at 14.0 days. The complication rate was 3.5%, with 4 complications (1.5%) associated with OT and 9 complications (5.1%) associated with PT. All complications in the PT group occurred before using a single dilator system. The 9 complications in the PT group occurred among 5 surgeons, all before their 11th attempt. PT saves $444 in charges per procedure. Conclusion OT continues to be a safe method of performing tracheostomies. PT has a steep learning curve but can be mastered quickly. Benefits include a shorter time to tracheostomy, elimination of patient transport, and saving in charges. Initial PT attempts should be supervised by an experienced surgeon.

Is Tracheal Stenosis Caused by Percutaneous Tracheostomy Different From That by Surgical Tracheostomy?

To compare the surgical findings of tracheal stenosis caused by percutaneous tracheostomy (PCT) and surgical tracheostomy (SGT). A combined prospective (from 2001 to 2003) and retrospective (from 1993 to 2001) observational study of the patients undergoing tracheal resection and reconstruction for treatment of tracheal stenosis following PCT or SGT in a national referral center for thoracic surgery in the United Kingdom. We studied 29 patients presenting with symptomatic tracheal stenosis requiring tracheal reconstruction. We recorded the demographic data, duration of mechanical ventilation, onset of tracheal stenosis after decannulation, and type of tracheostomy (PCT or SGT) from referral notes. Tracheal reconstruction was preceded by rigid bronchoscopy, through which the distance of the superior level of stenosis to the vocal cords, and the length and the diameter of stenosis were measured. The type of surgical technique for tracheal resection was also recorded. We then compared the stenosis caused by PCT (n = 15) and SGT (n = 14) using an unpaired t test, Mann-Whitney U test, or Fisher exact test as appropriate for statistical analysis. The mean distance from the superior level of stenosis in the PCT group was significantly closer to the vocal cords compared with the mean distance in the SGT group: 1.6 cm (95% confidence interval [CI], 1.1 to 2.1) vs 3.4 cm (95% CI, 2.3 to 4.5), respectively (p = 0.04). The mean onset of stenosis was significantly earlier in the PCT group compared to the SGT group: 5.0 weeks (95% CI, 5.0 to 6.0) vs 28.5 weeks (95% CI, 12 to 84), respectively (p = 0.009). Seven of 15 patients in the PCT group required partial cricoid resection and a mucosal flap, compared with 1 of 14 patients in the SGT group, although the difference did not reach statistic significance (p = 0.23). Stenosis caused by PCT occurred earlier and was subglottic in nature compared to that by SGT. Surgical correction of stenosis was more difficult in the PCT group due to its presentation in the subglottic area.

Bronchoscopic guidance makes percutaneous tracheostomy a safe, cost-effective, and easy-to-teach procedure

We wanted to assess the efficiency of instituting a modified technique of percutaneous tracheostomy (PET) with bronchoscopic guidance. During a 10-month period 48 consecutive trauma patients requiring tracheostomy were divided between a standard tracheostomy control group (ST) and a PET group. All patients were followed prospectively. The hospital charges were reviewed retrospectively. Age, gender, body habitus, and principal diagnosis were similar in the 21 ST patients and the 27 PET patients. All STs and 15 of the PETs were performed in the operating room (OR), and the 12 remaining PETs were done in the intensive care unit (ICU). Four patients in the ST group and six in the PET group died. One of these deaths occurred in a patient in the PET group with severe adult respiratory distress syndrome. Procedure time was shorter for PET (16 versus 45 minutes, p < 0.0001). Junior residents performed more PETs than STs (33% versus 10%), and PET was considered "easier" to perform than ST (81% versus 47%). Hospital charges for PET in the ICU were $3400 less per patient compared with ST or PET in the OR. PET was performed easily and safely in the OR and at the ICU bedside. PET required one-third the time of ST. Bronchoscopic supervision of PET may have contributed to the small number of complications and the educational experience of junior residents. PET in the ICU can reduce hospital charges significantly and avoids transport of patients to the OR. PET is as safe as ST and should be considered the procedure of choice for an ICU patient requiring an elective tracheostomy.