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KMID : 0361020190620050288
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Korean Journal of Otolaryngology - Head and Neck Surgery
2019 Volume.62 No. 5 p.288 ~ p.293
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Comparison of Surgical Tracheostomy and Percutaneous Dilatational Tracheostomy in Intensive Care Unit Patients
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Shin Hyun-Il
Jang Kyung-Il
Kim Kyung-Min
Nam In-Chul
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Abstract
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Background and Objectives: Percutaneous dilatational tracheostomy (PDT) has become an increasingly popular method of establishing an airway for patients in need of chronic ventilator assistance. The aim of this study is to assess and compare two main strategies for doing tracheostomy: traditional open surgical tracheostomy (ST) and PDT.
Materials and Method: We retrospectively reviewed medical records of 43 patients who underwent tracheostomy between the years 2016 and 2017. All patients were under intensive care unit (ICU) care and referred to the department of otolaryngology for tracheostomy. All tracheostomies were performed at the bedside using either percutaneous dilatational technique or open surgical technique by a single surgeon. In cases of PDT, either blind puncture technique without any guidance or laryngoscopy-guided puncture technique was used. Demographic and procedural variables and complications were compared between the two groups.
Results: PDT was performed in 29 patients and ST in 14 patients. Of those who underwent PDT, 15 patients received the blind puncture technique and 14 patients laryngoscopy-guided puncture technique. The cricosternal distance was longer and the amount of blood loss and duration of the procedure was lesser in the PDT group. In the PDT group, there was no difference in blood loss nor in the duration of the procedure according to the puncture technique, whereas critical complications occurred more frequently when the blind technique was used. Subjective difficulty of the procedure is predictive of complications.
Conclusion: The study show that PDT is a useful and safe procedure for ICU patients. Also, guidance on using the flexible laryngoscopy during PDT can prevent severe complications.
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KEYWORD
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Complications, Intensive care unit, Tracheostomy
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