Percutaneous tracheostomy: prospective comparison of the translaryngeal technique versus the forceps-dilational technique in 100 critically ill adults.

OBJECTIVE

To compare two different techniques of percutaneous tracheostomy: Griggs' forceps-dilational technique and Fantoni's translaryngeal technique, both performed with the manufacturer's basic kit and with bronchoscopic guidance.

DESIGN

A prospective, randomized trial was designed to compare the two tracheostomy techniques. Critically ill patients requiring elective tracheostomy for long-term ventilation were randomized for translaryngeal tracheostomy or forceps-dilational tracheostomy.

SETTING

Intensive care unit of a military teaching hospital.

PATIENTS

A total of 100 adult patients in the intensive care unit who were mechanically ventilated.

PROCEDURES

All tracheostomy procedures were performed at the bedside by using a commercially available set. The procedures were performed by two surgeons, one for bronchoscopic guidance and management of the airway and one for the tracheostomy.

MEASUREMENTS AND MAIN RESULTS

The measurements were divided into procedure-related variables (duration, technical difficulties, oxygenation): major and minor complications. The procedure was longer in the translaryngeal technique group (12.9 vs. 6.9 mins, p =.0018). Technical difficulties occurred in 11 patients in the translaryngeal technique group. Uneventful forceps dilational tracheostomy was performed instead. There has been no mortality associated with either technique. Serious complications occurred in one patient in the forceps-dilational technique group (one posterior tracheal wall injury) and in four patients in the translaryngeal technique group (one with a posterior tracheal wall injury and three with severe hypoxia). Significant hypercarbia and acidosis occurred in both the translaryngeal technique group and the forceps-dilational technique group. A significant decrease in Pao2 was observed in the translaryngeal technique group (311 to 261, p =.0069). No bleeding requiring intervention occurred.

CONCLUSIONS

Serious complications related to percutaneous tracheostomy occurred in 8.5% and 1.8% of the cases in the translaryngeal technique and the forceps-dilational technique group, respectively (p <.001). Technical difficulties were not rare when using the translaryngeal technique (23%). On the basis of our results, we concluded that the forceps-dilation technique is superior to the translaryngeal technique, with fewer technical difficulties and fewer complications for critically ill patients.