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Percutaneous dilation tracheotomy versus surgical tracheotomy: Our experience

Percutaneous dilation tracheotomy versus surgical tracheotomy: Our experience,10.1067/mhn.2003.90,Otolaryngology-head and Neck Surgery,David Goldenber

Percutaneous dilation tracheotomy versus surgical tracheotomy: Our experience   (Citations: 14)
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Background: Percutaneous dilation tracheotomy (PDT) is becoming a popular alternative to surgical tracheotomy. In our department, we recently adopted the use of the PDT in intensive care unit patients. Here, we compare the results of the use of these 2 techniques on 150 patients, all performed by the same surgeon. We discuss the pros and cons of PDT and present our experience with the technique compared with surgical tracheotomy (ST).Materials and Methods: A prospective study of 75 PDTs and a retrospective study of 75 surgical tracheotomies (ST) were performed at the Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center, Haifa, Israel. Age, sex, duration of intubation before surgery, time interval between the decision to perform and the performance of tracheotomy, and cost were compared.Results: One hundred fifty tracheotomies were reviewed. The indication for tracheotomy in both groups was prolonged mechanical ventilation. Seven patients were found unsuitable for PDT and underwent ST. Complications included 3 cases of mild postoperative hemorrhage in the ST group, and 1 case of subcutaneous emphysema, 1 case of stomal cellulitis and 2 cases of mild postoperative hemorrhage in the PDT group. The average waiting interval was between 2 to 5 days for ST and 1 to 24 hours for PDT. The intraoperative time for ST was 20 minutes; for PDT, 5 minutes. The cost was $565 for ST and $274 for PDT.Conclusions: PTD provides an easy, less expensive, and convenient alternative to ST and should be added to the otolaryngologists' armamentarium of surgical airway procedures. The procedure is advantageous for the patient. Complication rates of both techniques are similar and low; however, PDT is a blind technique of obtaining a surgical airway and therefore holds more potential for serious complications. It is our conclusion that this technique is suitable for many, but not all, critical care patients and that the procedure should be performed only by surgeons who are capable of urgently obtaining a surgical airway or exploring the neck should the PDT fail. (Otolaryngol Head Neck Surg 2003;128:358-63.)
Journal: Otolaryngology-head and Neck Surgery - OTOLARYNGOL HEAD NECK SURG , vol. 128, no. 3, pp. 358-363, 2003
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    • ...13 Goldenberg et al. [27] Comparative study (CS) III No power analysis; nonrandomized; methodologically Xawed 14 Kaylie et al. [11] Randomized controlled trial (RCT) III No power analysis; not blinded randomization; small number; methodologically Xawed 15 Khalili et al. [28] Comparative study (CS) III No power analysis; not well conducted...

    Sotirios Pappaset al. Surgical versus percutaneous tracheostomy: an evidence-based approach

    • ...The beneWts of early tracheotomy outweigh the risks of prolonged translaryngeal intubation [43], provided that the procedure is performed by the same team of trained surgeons [39, 46], and the technique has been shown to be safe and eVective in the intensive care unit (ICU) environment [2, 13, 20, 23, 34]...
    • ...Subcutaneous emphysema can be observed in 2% of cases with PDT [18] because the short incision does not allow the air to escape [12, 20]...
    • ...We full agree that PDT must always be performed by surgeons trained in the technique and familiar with head and neck surgery [20, 21, 29, 39, 43]...

    Marc Remacleet al. Comparison between the Percutwist ® and the Ciaglia ® percutaneous tra...

    • ...Goldenberg et al. found similar and low complication rates for COT and PCT [11]...
    • ...A limited ability to extend the cervical spine is considered a contraindication for PCT [11]...

    R. Barkhuysenet al. Acute upper airway failure and mediastinal emphysema following a wire-...

    • ...When comparing PDT with surgical tracheostomy, some researchers suggested the potential advantages of PDT, including ease of performance, lower incidence of peri-stromal bleeding and post-operative infection, convenience, and lower costs. (6,7)...

    Chien-Tung Chiuet al. Weaning of Long-Term Mechanically-Ventilated Patients Following Video ...

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