Percutaneous dilatational tracheostomy versus translaryngeal tracheostomy - a prospective randomized trial in 50 critically ill patients

Percutaneous dilatational tracheostomy (PT) and translaryngeal tracheostomy (TLT) are relatively new minimally invasive methods for critically ill patients. To compare the perioperative procedural safety we analyzed the severity of perioperative blood gas changes in a prospective randomized clinical study in 50 patients (34 men, 16 women; age 18-84 years). Additionally, early complications were documented. Twenty five PTs and 25 TLTs were performed under tracheoscopic guidance. Perioperative hypoxia did not occur in either group; however, a decrease of PaO2 of more than 50 mm Hg was noticed in nine patients during TLT versus three patients with PT (P = 0.051). The mean increase of PaCO2 was significantly higher in the TLT-group (5.2 +/- 6.7 vs 11.6 +/- 8.4 mmHg; P < 0.01). In the PT group no perioperative complications arose; in the TLT group one procedure was not successful and had to be converted to a PT. Postoperatively, one premature decannulation (PT group) and one bleeding (TLT group) were noticed. PT and TLT are safe methods. Early complications are rare in experienced hands. TLT tends to cause relevant hypercarbia and should therefore be restricted to patients without special risks.