THE COMPARISON OF PERCUTANEOUS AND SURGICAL TRACHEOSTOMY IN NEUROSURGERY INTENSIVE CARE UNIT: A CLINICAL RESEARCH

Aim: Tracheostomy is one of the most common procedures performed in trauma patients in the intensive care unit for ceasing from mechanical ventilation. Open tracheostomy involves dissection of the pretracheal tissues, and insertion of the tracheostomy cannula into the trachea under direct vision. Percutaneous dilatational tracheostomy is increasingly popular and has gained widespread popularity in many intensive care unit and trauma centers. Aim of the study was to compare percutaneous dilatational tracheostomy with conventional open tracheostomy in many ways at neurosurgery intensive care. Patients and Methods: 49 critically ill patients admitted to intensive care unit subjected to tracheostomy and randomly divided into two groups; percutaneous tracheostomy and conventional open tracheostomy. Three separate neurosurgeon who was in charge at neurosurgical intensive care unit performed the process as in bedside. Results: According to process times, the percutaneous tracheostomy was found to take significantly shorter duration compared to standard tracheostomy (p=0,0001). Also, the rate of subcutaneous emphysema and intra-operative bleeding is statistically lower at percutaneous tracheostomy group (p0.05). Moreover, postop complications such as wound infection, Tube dislodgement, delayed closure, Tracheal stenosis and unesthetic scar was detected in the lower figure, but it was not meaningful at all. After operation; bleeding, pneumothorax, vocal cord paralysis for both groups were nearly similar without any statistically difference.Conclusion: Percutaneous technique is effective and safe with low incidence of per and postoperative complication. The risk of complication is significantly lowered after percutaneous than open tracheostomy.

THE COMPARISON OF PERCUTANEOUS AND SURGICAL TRACHEOSTOMY IN NEUROSURGERY INTENSIVE CARE UNIT: A CLINICAL RESEARCH

Aim: Tracheostomy is one of the most common procedures performed in trauma patients in the intensive care unit for ceasing from mechanical ventilation. Open tracheostomy involves dissection of the pretracheal tissues, and insertion of the tracheostomy cannula into the trachea under direct vision. Percutaneous dilatational tracheostomy is increasingly popular and has gained widespread popularity in many intensive care unit and trauma centers. Aim of the study was to compare percutaneous dilatational tracheostomy with conventional open tracheostomy in many ways at neurosurgery intensive care. Patients and Methods: 49 critically ill patients admitted to intensive care unit subjected to tracheostomy and randomly divided into two groups; conventional open tracheostomy. Three separate neurosurgeon who was in charge at neurosurgical intensive care unit performed the process as in bedside

___

  • Cox CE, Carson SS, Holmes GM, Howard A, Carey TS: Increase in tracheostomy for prolonged
  • mechanical ventilation in North Carolina, 1993–2002. Crit Care Med 2004, 32:2219-2226.
  • Needham DM, Bronskill SE, Calinawan JR, Sibbald WJ, Pronovost PJ, Laupacis A: Projected
  • incidence of mechanical ventilation in Ontario to 2026: Preparing for the aging baby boomers. Crit
  • Care Med 2005, 33:574-579.
  • McWhorter AJ: Tracheotomy: timing and techniques. Curr Opin Otolaryngol Head Neck Surg 2003,
  • :473-479.
  • Shelden C, Pudenz R: Percutaneous tracheotomy. J Am Med Assoc 1957, 165:2068-2070.
  • Ciaglia P, Firsching R, Syniec C: Elective percutaneous dilata- tional tracheostomy. A new simple
  • bedside procedure; prelim- inary report. Chest 1985, 87:715-719.
  • Blot F, Melot C: Indications, timing, and techniques of trache- ostomy in 152 French ICUs. Chest
  • , 127:1347-1352.
  • Fikkers BG, Fransen GA, van der Hoeven JG, Briede IS, van den Hoogen FJ: Tracheostomy for long-term ventilated patients: a postal survey of ICU practice in The Netherlands. Intensive Care Med
  • , 29:1390-1393.
  • Fischler L, Erhart S, Kleger GR, Frutiger A: Prevalence of trache- ostomy in ICU patients. A nationwide
  • survey in Switzerland. Intensive Care Med 2000, 26:1428-1433.
  • Krishnan K, Elliot SC, Mallick A: The current practice of tracheostomy in the United Kingdom: a
  • postal survey. Anaesthesia 2005, 60:360-364.
  • Jackson C. Tracheostomy. Laryngoscope. 1909; 19:285–290.
  • Chew JY, Cantrell RW. Tracheostomy: complications and their management. Arch Otolaryngol. 1972;
  • :538–545.
  • Stauffer JL, Olson DE, Petty TI. Complication and consequences of endotracheal intubation and
  • tracheotomy. A prospective study of 150 critically ill adult patients. Am J Med. 1981;70:65–76.
  • Stock MC, Woodward CG, Shapiro BA, et al. Perioperative complications of elective tracheostomy in
  • critically ill patients. Crit Care Med. 1986; 14:861–863.
  • Dayal VS, Masri W. Tracheostomy in intensive care setting. . Laryngoscope. 1986; 96:58–60.
  • Astrachan DI, Kirchner JC, Goodwin WJ. Prolonged intubation vs tracheotomy: complications,
  • practical and psychological considerations. . Laryngoscope. 1988; 98:1165–1169.
  • Zeitouni AG, Kost MK. Tracheostomy: a retrospective review of 281 cases. J Otolaryngol. 1994;
  • :61–66.
  • Westphal K, Maeser D, Scheifler G, et al. A new single-dilator technique for percutaneous
  • tracheostomy. Anesth Ana
  • Türkmen A, Altan A, Turgut N, et al. Comparison of percutaneous dilatational tracheostomy with
  • surgical tracheostomy. Middle East J Anesthesiol. 2008; 19(5):1055–1067.
  • Shelden C, Pudenz R: Percutaneous tracheotomy. J Am Med Assoc 1957, 165:2068-2070.
  • Toy FJ, Weinstein JD. A percutaneous tracheostomy device. Surgery. 1969; 65:384–389.
  • Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy: a new simple
  • bedside procedure: preliminary report. Chest. 1985; 87:715–719.
  • Schachner A, Ovil Y, Sidi J, et al. Percutaneous tracheostomy: a new method. . Crit Care Med. 1989;
  • :1052–1056.
  • Griggs WM, Worthley LIG, Gilligan JE, Thomas PD, Myburg JA. A simple percutaneous
  • tracheostomy technique. Surgery. 1990;170:543–545.
  • Heikkinen M, Aarnio P, Hannukainen J. Percutaneous dilational tracheostomy or conventional
  • surgical tracheostomy? Crit Care Med. 2000; 28(5):1399–1402.
  • Caldicott LD, Oldroyd GJ, Bodenham AR. An evaluation of a new percutaneous tracheostomy kit.
  • Anaesthesia. 1995; 50:49–51.
  • Leinhardt DJ, Mughal M, Bowles B, et al. Appraisal of percutaneous tracheostomy. Br J Surg. 1992;
  • :255–258.