Percutaneous tracheostomy: A comprehensive evaluation

Percutaneous tracheostomy (PT) is an ancient procedure that has recently at tracted increasing interest. While there are numerous publications in the l iterature, there remains confusion due to the large variety of techniques a nd instruments with which it has been performed and the wide disparity in c linical outcome. This study evaluates the international literature on over 1,500 cases, classifies the techniques that have been used, analyzes the sa fety of each method, and reports a prospective outcome and cost analysis of 130 cases undergoing what we determined to he the safest method. We found that PT performed with the correct instruments and technique under bronchos copic surveillance has a lower incidence of complications than open tracheo stomy (OT). Cost estimation demonstrated that PT may be significantly more expensive than bedside OT. While we recommend PT as a relatively safe and e xpedient method of tracheostomy for selected intubated patients in an inten sive care unit, it does not offer an advantage for patients who must be tak en to the operating room, and should not deprive house officers of necessar y experience in OT in this setting.