Comparison of two different percutaneous tracheostomy techniques with early and late complications in critically ill patients

Background

Percutaneous tracheostomy (PT) is used in patients who receive long-term invasive mechanical ventilation. There are many different techniques in performing PT.

Aim

The aim of this prospective study was to compare two different PT techniques with early and late complications in critically ill patients.

Methods

After obtaining ethical committee approval, 60 adult patients were assigned randomly into two groups. Forceps dilatational PT and single-step dilatational PT were used in group F and group P, respectively. Heart rate, blood pressure and peripheral oxygen saturation, the level of tracheal entrance and number of punctions, major and minor complications and duration of the procedure were recorded during the procedure. Arterial blood samples were taken before the incision and after tracheostomy cannula was inserted, then pH, pCO₂, pO₂, HCO₃, BE, and SaO₂ were recorded. The endoscopic examinations of the cases were done during the procedure, at the decannulation time and 1 month after decannulation. The t test, Mann–Whitney U test, Wilcoxon signed rank test, chi-squared test and Kruskal–Wallis test were used for statistical analysis.

Results

The demographic data, duration of intubation time and procedure time were similar in both groups. There were no significant differences in hemodynamic data between the groups. It was noticed that in both groups there was a decrease in pH (P < 0.001) and an increase in pCO₂ (P < 0.01). Tracheal ring damage that was one of the minor complications in Group P was significantly gretaer (P < 0.05). There were no significant differences in major complications between the groups. In Group F tracheal stenosis in one case and laryngotracheal separation in another case were detected with endoscopic examination.

Conclusion

The present study demonstrated that single-step dilatational PT may be an alternative to forceps dilatational PT, but we conclude that to maintain a decrease in complications endoscopic visualisation could be used.