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Abstract
Introduction
In our ICU we use modified bedside operative tracheostomy. The operation consists
of consecutive blunt dilatation of all tissular structures above the trachea with
the aim of denudating it. After that we execute a small incision of the trachea between
the second and the third annulus, dilatation of trachea and insertion of a tracheostomy
cannula with the possibility of an adjustment tracheal aperture. There is no need
for ligation of the thyroideal isthmus or resection of the tracheal cartilage.
The aim of this study was to compare our method with surgical tracheostomy (ST) and
percutaneous dilation tracheostomy (PDT-Ciaglia) for early and long-term complications.
Method
The group of 205 patients with tracheostomy was included in our observation (hospitalized
1997–2001 in our ICU) without exceptions (basic diagnosis, indication of tracheostomy,
anatomical conditions and other risk factors to the results of the operation). Data
of long-term complications were gained from a questionnaire. Data of ST and PDT were
taken from medical literature. Descriptive statistical methods and the Student t test
were used to analyze the data.
Results
Results in percent of complications are graphically demonstrated in Figs 1,2,3.
Figure 1
Comparison of early complications of the visual technique with PDT.
Figure 2
Comparison of early complications of the visual technique with ST.
Figure 3
Comparison of long-term complications of the visual technique with PDT.
The total complication rate for our method was found to be 11.7%. Incidence of bleeding
(perioperative and postoperative) was 5.3%. There was no need for use of transfusions.
Infectious complications were 5.9%. Other complications including pneumothorax, pneumomediastinum,
subcutaneus emphysema and other minor complications were 0.5%.
The total number of patients who were discharged from our hospital was 67. Rate of
return of the questionnaire was 46%. Long-term complications were: none of the patients
developed laryngotracheal stenosis, cosmetic difficulties with cicatrice (23%), voice
changes (15%), and dysphagia (8%).
Conclusions
Our method of tracheostomy can be an accepted procedure for airway access. The rate
of complications is comparable with other methods (PDT, ST). There are also important
differences in costs. The cost of the described method is one-third of the cost of
PDT in Czech conditions. Prospective randomized studies are necessary to compare the
late complications of these reported techniques.