Percutaneous dilational tracheostomy or conventional surgical tracheostomy?

Objective: Percutaneous dilational tracheostomy (PDT) is increasingly used in intensive care units (ICU), and it has a low incidence of complications. The aim of this study was to compare the costs, complications, and time co nsumption of PDT with that of conventional surgical tracheostomy (ST) when both procedures were performed in the ICU. Design: The study was a prospective, randomized trial. Setting: The procedures were performed routinely in the ICU of Satakunta Ce ntral Hospital. Patients: During a 23-month period from December 1995 to November 1997, 30 patients underwent PDT and 26 patients had ST. In one patient, PDT was conv erted to ST. All patients were receiving ventilation in the ICU, and all tr acheostomies were performed at the patient's bedside in the ICU. The Porter percutaneous tracheostomy kit was used for all PDTs. Results: The mean time to perform PDT was 11 mins (SD, 6; range, 2-40), and the mean time to perform ST was 14 mins (SD, 6; range, 3-39). In the PDT g roup, five patients had moderate bleeding during the procedure. In three pa tients, the bleeding was resolved with compression; in one patient, it was resolved with ligation of the vessel; and in one patient, it was resolved w ith electrocoagulation. Bleeding did not cause any complications afterward. In the PDT group, one patient had minimal oozing from the wound edge on th e first postoperative day and it was resolved spontaneously. In the ST grou p, there were no intraprocedural complications. One patient had bleeding fr om the wound on first postoperative day. The sutures were removed, and the bleeding vessel was ligated. The mean cost (in U. S. dollars) of PDT was $1 61 (SD, 10.4; range, $159-$219), and the mean cost of ST was $357 (SD, $74; range, $239-$599). The cost of PDT was significantly lower than the cost o f ST (p < .001). Conclusion: We found that PDT is a cost-effective procedure in critically i ll ICU patients. Although we performed ST at the bedside in the ICU to avoi d the risks associated with moving critically ill patients to the operating room, we found PDT to be a simple and safe procedure.