Compare and contrast percutaneous and surgical tracheostomy.
Surgical tracheostomy is the time-honoured approach. Best operating conditions (coping with complexities of anatomy), best control of bleeding and airway. Requires operating time and staff, and transport to operating theatre. Lower incidence of peri-operative complications. Higher incidence of tracheal stenosis, postoperative bleeding and stomal infection.
Percutaneous tracheostomy refers to a number of different techniques. In particular the gradual dilatation [Ciaglia], forceps dilation [Griggs], Rhino and translaryngeal techniques. Most comparative data is for the Ciaglia technique. Blind external technique (which can be bronchoscopy assisted to improve visualization/placement) which seems to be significantly operator dependent. Some neck anatomy problems provide relative contraindications. Permits smaller incision, but lesser exposure and not usually performed with diathermy available. Only require intensive care staff, though airway maintenance is probably more critical, with respiratory acidosis and loss of airway more likely. No delays due to theatre requirements, no transport required, and takes less time to perform. Higher incidence of anterior tracheal wall injury and posterior wall perforation. Lower incidence of postoperative haemorrhage, infection and tracheal stenosis.
This question lends itself well to a tabulated answer.
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Surgical tracheostomy |
Percutaneous tracheostomy |
Advantages |
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Disadvantages |
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