Dilatation tracheostomy under visual control

Introduction

In our ICU we use modified bedside operative tracheostomy. The operation consists of consecutive blunt dilatation of all tissular structures above the trachea with the aim of denudating it. After that we execute a small incision of the trachea between the second and the third annulus, dilatation of trachea and insertion of a tracheostomy cannula with the possibility of an adjustment tracheal aperture. There is no need for ligation of the thyroideal isthmus or resection of the tracheal cartilage.

The aim of this study was to compare our method with surgical tracheostomy (ST) and percutaneous dilation tracheostomy (PDT-Ciaglia) for early and long-term complications.

Method

The group of 205 patients with tracheostomy was included in our observation (hospitalized 1997–2001 in our ICU) without exceptions (basic diagnosis, indication of tracheostomy, anatomical conditions and other risk factors to the results of the operation). Data of long-term complications were gained from a questionnaire. Data of ST and PDT were taken from medical literature. Descriptive statistical methods and the Student t test were used to analyze the data.

Results

Results in percent of complications are graphically demonstrated in Figs 1,2,3.

Figure 1

Comparison of early complications of the visual technique with PDT.

Figure 2

Comparison of early complications of the visual technique with ST.

Figure 3

Comparison of long-term complications of the visual technique with PDT.

The total complication rate for our method was found to be 11.7%. Incidence of bleeding (perioperative and postoperative) was 5.3%. There was no need for use of transfusions. Infectious complications were 5.9%. Other complications including pneumothorax, pneumomediastinum, subcutaneus emphysema and other minor complications were 0.5%.

The total number of patients who were discharged from our hospital was 67. Rate of return of the questionnaire was 46%. Long-term complications were: none of the patients developed laryngotracheal stenosis, cosmetic difficulties with cicatrice (23%), voice changes (15%), and dysphagia (8%).

Conclusions

Our method of tracheostomy can be an accepted procedure for airway access. The rate of complications is comparable with other methods (PDT, ST). There are also important differences in costs. The cost of the described method is one-third of the cost of PDT in Czech conditions. Prospective randomized studies are necessary to compare the late complications of these reported techniques.