Given that this is a very ICU-oriented procedure, the topic of percutaneous tracheostomy has come up several times in the exam. Specifically, in Question 10 from the first paper of 2014 and Question 6 from the first paper of 2002 the candidates were expected to weight the risks and benefits of this procedure as compared to surgical tracheostomy, as well as on its own merits.
The answer to Question 6 may act as a good short summary of advantages and disadvantages. For the majority of the ensuing discussion, the Ciaglia technique will be used as the default percutaneous tracheostomy technique.
In short
|
Surgical tracheostomy |
Percutaneous tracheostomy |
Advantages |
|
|
Disadvantages |
|
|
"With regard to rates of mortality, intraoperative hemorrhage, and postoperative hemorrhage, there was no statistically significant difference between the two techniques" - this was the conclusion of the meta-analysis by Johnson-Obaseki et al (2016). The same authors found that the post-procedure infection rate was lower with the percutaneous technique. The difference between this meta-analysis and the meta-analysis by Dulguerov et al (1999) probably reflects how the safety of the percutaneous technique has improved over time, thereby decreasing the intraoperative complication rate. The comparatively lacklustre performance of the surgical technique can perhaps be attributed to the fact that these days only the most technically difficult tracheostomies are being performed surgically.
The abovementioned meta-analysis from Johnson-Obaseki et al (2016) found that the procedure time was faster for the percutaneous technique.
The risk of tracheal stenosis was found to be higher for surgical tracheostomy - though only as a trend, rather than a firm association (Dempsey et al, 2016)
Durbin, Charles G. "Indications for and timing of tracheostomy." Respiratory care 50.4 (2005): 483-487.
Kilic, Dalokay, et al. "Article When is Surgical Tracheostomy Indicated? Surgical “U-shaped” versus Percutaneous Tracheostomy." Ann Thorac Cardiovasc Surg 17.1 (2011): 29-32.
De Leyn, Paul, et al. "Tracheotomy: clinical review and guidelines." European Journal of Cardio-thoracic Surgery 32.3 (2007): 412-421.
Friedman, Yaakov, et al. "Comparison of percutaneous and surgical tracheostomies." CHEST Journal 110.2 (1996): 480-485.
Dulguerov, Pavel, et al. "Percutaneous or surgical tracheostomy: a meta-analysis." Critical care medicine 27.8 (1999): 1617-1625.
Duann, Chi‐Wei, et al. "Successful percutaneous tracheostomy via puncture through the thyroid isthmus." Respirology Case Reports 2.2 (2014): 57-60.
Friedman, Yaakov, et al. "Comparison of percutaneous and surgical tracheostomies." CHEST Journal 110.2 (1996): 480-485.
Dulguerov, Pavel, et al. "Percutaneous or surgical tracheostomy: a meta-analysis." Critical care medicine 27.8 (1999): 1617-1625.
Griffiths, John, et al. "Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation." Bmj 330.7502 (2005): 1243.
Johnson‐Obaseki, Stephanie, Andrea Veljkovic, and Hedyeh Javidnia. "Complication rates of open surgical versus percutaneous tracheostomy in critically ill patients." The Laryngoscope (2016).
Dempsey, Ged A., et al. "Long-Term Outcome Following Tracheostomy in Critical Care: A Systematic Review." Critical Care Medicine (2016).