Surgical tracheostomy versus percutaneous dilatational tracheostomy - A prospective-randomized study with long-term follow-up

Background. To compare surgical tracheostomy (ST) versus percutaneous; dilatational tracheostomy (PDT) in terms of complication rates. in particular we specifically studied the late tracheal complications of both methods by means of endoscopic controls of patients up to 6 months after the procedures. Methods. Design: prospective-randomized clinical study. Setting: University-affiliated tertiary care referral hospital. Patients: 50 consecutive translaryngeally intubated patients with respiratory failure were randomized to undergo either ST (25 patients) or endoscopic guided PDT (25 patients). Results. ST was performed in 41+/-14 min versus 14+/-6 min for PDT (p<0.0001). There was no procedure-related death. in the ST group there were no intraoperative complications. In the PDT group 2 intraoperative complications (minor hemorrhages) were observed. in the ST group 9 early postoperative complications occurred: one minor bleeding, 7 stomal infections and one accidental decannulation. In the PDT group only one early postoperative complication (minor bleeding) occurred. Early postoperative complication rates were 36% for ST and 4% for PDT. In the ST group there were no late tracheal complications. in the PDT group 2 late tracheal complications (one segmental malacia and one stenosis at the level of the stoma) were observed. Conclusions. This study confirms that PDT is a simpler and quicker procedure than ST and that it has a lower rate of early postoperative complications. Late tracheal complications were more frequent, although the difference was not statistically-significant, in the PDT group. Further investigations of long-term outcome following PDT are therefore necessary.