A Comparison of Percutaneous Dilatational Tracheostomy Versus Conventional Surgical Tracheostomy

Abstract

Background: Percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) are widely accepted techniques and frequently performed in clinical practice. We compared PDT with ST tracheostomies in view of the benefits and drawbacks, time of duration, indication and complication rate of the respective procedures.

Methods: The evaluation was based on data from 378 tracheostomies. 209 of these tracheostomies were performed at bedside as PDT in the intensive care unit. These were compared to 169 ST tracheostomies performed in the operating room. All interventions were performed by the same team of surgeons or intensivists, however, at different training levels.

Results: The mean duration of the operation was shorter for PDT than for ST (18.2 ± 10 min versus 38.2 ± 14.2 min, p = < 0.001). The PDT was a simpler procedure and performed predominantly by physicians in postgraduate training. The rate of complications was low in both groups (8.6 % PDT, 8.3 % ST, p = 0.909).

Conclusion: Although both interventions are safe and achieve comparable results, PDT can be applied in a shorter time. PDT is easier to perform and seems particularly suitable for physicians in postgraduate training.

Zusammenfassung

Hintergrund: Die perkutane Dilatationstracheotomie (PDT) und die chirurgische Tracheotomie (ST) sind beide anerkannte Verfahren. Diese Studie vergleicht PDT- mit ST-Tracheotomien im Hinblick auf die Vor- und Nachteile, Eingriffsdauer, Indikationsstellung und Komplikationsrate der jeweiligen Prozeduren.

Patienten: Die Daten von 378 Tracheotomien wurden retrospektiv ausgewertet. 209 der Tracheotomien wurden als PDT bettseitig auf der Intensivstation ausgeführt, 169 ST-Tracheotomien wurden im OP ausgeführt. Alle Eingriffe wurden vom selben Operationsteam ausgeführt, deren Operateure jedoch einen unterschiedlichen Ausbildungsstand hatten.

Ergebnisse: Die Eingriffsdauer war bei der PDT kürzer als bei der ST (18,2 ± 10 min versus 38,2 ± 14,2 min, p < 0.001). Die PDT war eine einfachere Prozedur und wurde überwiegend von Ärzten in Weiterbildung durchgeführt. Die Komplikationsrate war in beiden Gruppen vergleichbar gering (8,6 % PDT versus 8,3 % ST, p = 0.909).

Schlussfolgerungen: Beide Methoden stellten sich als sicher heraus und erzielten vergleichbare Resultate. PDT kann in kürzerer Zeit durchgeführt werden und erscheint als die einfachere Methode. Die PDT ist somit auch von Operateuren in Ausbildung gut durchführbar.

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