Is Tracheal Stenosis Caused by Percutaneous Tracheostomy Different From That by Surgical Tracheostomy?

Abstract Background Various complications may arise from prolonged mechanical ventilation, but the risk of tracheal stenosis occurring late after translaryngeal intubation or tracheostomy is less common. This study aimed to determine the prevalence, type, risk factors, and management of tracheal stenoses in mechanically ventilated tracheotomized patients deemed ready for decannulation following prolonged weaning. Methods A retrospective observational study on 357 prolonged mechanically ventilated, tracheotomized patients admitted to a specialized weaning center over seven years. Flexible bronchoscopy was used to discern the type, level, and severity of tracheal stenosis in each case. We described the management of these stenoses and used a binary logistic regression analysis to determine independent risk factors for stenosis development. Results On admission, 272 patients (76%) had percutaneous tracheostomies, and 114 patients (32%) presented mild to moderate tracheal stenosis following weaning completion, with a median tracheal cross-section reduction of 40% (IQR 25–50). The majority of stenoses (88%) were located in the upper tracheal region, most commonly resulting from localized granulation tissue formation at the site of the internal stoma (96%). The logistic regression analysis determined that obesity (OR 2.16 [95%CI 1.29–3.63], P < 0.01), presence of a percutaneous tracheostomy (2.02 [1.12–3.66], P = 0.020), and cricothyrotomy status (5.35 [1.96–14.6], P < 0.01) were independently related to stenoses. Interventional bronchoscopy with Nd:YAG photocoagulation was a highly effective first-line treatment, with only three patients (2.6%) ultimately referred to tracheal surgery. Conclusions Tracheal stenosis is commonly observed among prolonged ventilated patients with tracheostomies, characterized by localized hypergranulation and mild to moderate airway obstruction, with interventional bronchoscopy providing satisfactory results.

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Is Surgical Tracheostomy Really Superior to Percutaneous Tracheostomy?

Critical Care Medicine ◽

10.1097/00003246-200009000-00055 ◽

2000 ◽

Vol 28 (9) ◽

pp. 3369

Author(s):

L. W. Ernest van Heurn ◽

Graham Ramsay

Keyword(s):

Percutaneous Tracheostomy ◽

Surgical Tracheostomy

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Investigation of Percutaneous Tracheostomy and Surgical Tracheostomy

Nihon Kikan Shokudoka Gakkai Kaiho ◽

10.2468/jbes.58.472 ◽

2007 ◽

Vol 58 (5) ◽

pp. 472-477 ◽

Cited By ~ 2

Author(s):

Takashi Hirano ◽

Naoki Uemura ◽

Tetsuo Watanabe ◽

Masashi Suzuki

Keyword(s):

Percutaneous Tracheostomy ◽

Surgical Tracheostomy

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Comparison of Percutaneous Dilatational Tracheostomy with Open Tracheostomy in Intensive Care Unit

Journal of Institute of Medicine ◽

10.3126/jiom.v41i1.28584 ◽

2019 ◽

Vol 41 (1) ◽

pp. 1-7

Author(s):

Pramesh S Shrestha ◽

Moda N Marhatta ◽

Subhash P Acharya ◽

Ninadini Shrestha

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Percutaneous Tracheostomy ◽

Percutaneous Dilatational Tracheostomy ◽

Hospital Length Of Stay ◽

Apache Ii Score ◽

Time Duration ◽

Surgical Tracheostomy ◽

Dilatational Tracheostomy ◽

Emergency Procedures

Introduction: Tracheostomy is one of the frequent surgical procedure carried out in intensive care unit. Percutaneous tracheostomy is becoming increasingly popular compared to conventional open surgical tracheostomy in ICU. Methods: A prospective randomized trial with twenty patients in each group was conducted to compare the outcomes of percutaneous and surgical tracheostomy. Percutaneous tracheostomy was performed using Ciaglia Blue Rhino technique and surgical tracheostomy was performed using established technique. The outcomes were compared in relation to randomization to tracheostomy, completion of procedure, intra operative and post-operative complications, hospital length of stay and cost. Results: There were no major complications in either group. Most variables studied were not statistically significant. The two groups did not differ in terms of basic demographics or APACHE II score. The only variables to reach statistical significance were time duration from tracheostomy randomization to start of procedure and time taken for completion of procedure. It was mean 31.85±15.35 hours in Percutaneous Tracheostomy group and in Surgical Tracheostomy group it was mean 49.10±23.61 hours respectively (p<0.009). Time taken to perform percutaneous tracheostomy was mean 15.50±3.22 minutes and for surgical tracheostomy it was mean 20.30±3.38 minutes. (p<0.001). Conclusion: Percutaneous dilatational tracheostomy is simple, faster to perform and can be done at bedside to avoid considerable delay in the performance of open tracheostomy where there is high demand for elective and emergency procedures in operating room.

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