Percutaneous tracheotomy in critically ill patients: Prospective evaluation of two different techniques

Introduction and objectives: Percutaneous tracheotomy (PCT) is increasingly preferred to surgical tracheotomy for providing airway protection or ventilatory support in critically ill patients. Several methods of PCT have been developed but have not yet been prospectively compared. We therefore studied two commonly used PCT techniques: the Ciaglia® Percutaneous Introducer Set which is based on progressive dilatation and the Portex® tracheotomy set which uses a forceps approach. Design: Prospective, randomised study. Setting: Medico-surgical intensive care unit in a tertiary care University Hospital. Interventions: Under bronchoscopic control, 40 PCT procedures were performed by the same surgeon in 39 critically ill patients. Results: Twenty six patients were included in the Ciaglia and 14 patients in the Portex group. More elderly patients with higher APACHE III scores entered into the Portex group. Other patients' characteristics, duration of endotracheal intubation, length of stay in the unit and time to decannulation were comparable between groups. PCT placement was achieved with equal success in both groups. However, the procedure took less time in the Portex group (4.6 ± 0.2 vs. 7.3 ± 0.2 min; p < 0.001). Twenty three patients (59%) died, all of them with functional tracheostomy. Early complications were comparable between groups and included bleeding, impossible tracheal puncture, tracheal ring rupture and mucosal flap formation. One late complication (tracheal stenosis and delayed tracheostoma healing) occurred in each group. Conclusion: Both PCT techniques were confirmed to be relatively safe and easily performed at the bedside. However, the shorter procedure time may be an advantage for the Portex® technique.SCOPUS: ar.j