Percutaneous Tracheostomy - See It or Feel It: Systematic Comparison Between Two Methods

Background: Percutaneous dilatational tracheostomy (PDT) is routinely performed in the ICU, being as safe as surgical tracheostomy while being more economical. PDT is commonly performed either by manual anatomical location or under bronchoscopic guidance (FOB-PDT). FOB-PDT needs an extra operator, to perform the bronchoscopy. No systematic comparison has been made between the two methods.

Objective: To compare the efficacy, safety, and incidence of complications of PDT vs FOB-PDT.

Methods: RCT comparison of both tracheostomy techniques. We have already enrolled 34 patients (23 male), aged 21-95 years (median 60), 19 in the PDT group and 15 in the FOB-PDT group. The data collected include demographics, APACHE II, SOFA, procedure duration, complications, technical difficulties, experience with PDT and hemodynamics.

Results: So far, we have not found significant differences between the 2 groups among the tested variables, including the mean incidence of minor bleeding. A false lumen occurred during one PTD patient. One bronchoscopy had to be discontinued due to a large leak in the breathing circuit which caused desaturation. Complication rates were not higher when the operator lacked experience. There was no difference in the mean duration of the procedure for the FOB-PDT and PTD group, even when the confounder of the lack of experience with PDT was removed from the statistical analysis (4±1.29 min vs 2.5±1.19 min, p=0.4).

Conclusion: Our preliminary results from this ongoing study suggest that PDT is as safe as FOB-PDT. There is a trend towards shorter procedure time with PDT that did not reach statistical significance.