Percutaneous vs Open Tracheostomy for Critical Care Patients

Abstract

Objective: 1) Evaluate the indications for performing a tracheostomy across the spectrum of all trauma and pulmonary critical care patients. 2) Understand the existing contraindications used in the decision against performing a percutaneous dilatational tracheostomy. 3) Examine outcomes among the 2 modes of tracheotomy procedures.

Method: A retrospective review identifying all patients who underwent open surgical or percutaneous dilatational tracheostomy procedure spanning 3 years (from 2008) within a tertiary hospital. Clinical and demographic data were used to compare the 2 groups of patients with respect to average age, hospital stay, related ER visits, and other complications.

Results: A total of 1333 tracheostomies were performed on 1302 patients. This included 452 (34%) open surgical versus 881 (66%) percutaneous dilatational techniques. There was no significant difference in age between the 2 groups (53 years). The average length of hospital stay was 21 days, indifferent among the 2 groups. The majority of the total tracheostomies were performed by the surgical services, in comparison to the pulmonary critical care service, 1080 (81%) versus 253 (19%), respectively. Approximately 26% of all discharged patients had a related ER visit (respiratory or tracheostomy-related) within a year.

Conclusion: A majority of tracheostomies at our tertiary care trauma hospital are performed via the percutaneous technique. Both groups have similar short-term safety and complication rates. Our surprisingly high ER return rate suggests possible deficiency in pre-discharge teaching and care arrangements. Prospective studies are needed to determine long-term complications.