Fiberoptic-guided percutaneous dilatational tracheostomy versus surgical tracheostomy for intensive care ventilated patients

Background and objectives
The aim of the study was to compare the safety and efficacy of fiberoptic-guided percutaneous dilatational tracheostomy (FGPDT) with surgical tracheostomy (ST) in ICU ventilated patients.
Patients and methods
A prospective randomized double-blind study was performed to compare ST and FGPDT. In the ST group ( = 20), the procedure was performed by the same surgical team, ENT consultant and his assistant in operative theater. In the FGPDT group ( = 20), the procedure was performed at the bedside in the ICU by the same team, the anesthesia consultant and his assistant. All the steps of FGPDT were performed under the visual control of the fiberoptic bronchoscope. The duration of the procedure, hemodynamics, oxygenation parameters, skin incision size, number of trials during tubal insertion, and complications and adverse events arising during the procedure, immediately postoperatively, and throughout the patients continuing care for 2 weeks were assessed and recorded by ICU doctor blinded to the study.
Results
Forty patients were enrolled into the study, 20 patients for each group. Success in tracheostomy tube placement was found in 100% of patients in both groups. Regarding the procedure details, the mean size of skin incision was 3.7 ± 1.7 and 2 ± 0.6 for groups ST and FGPDT, respectively, and it was highly statistically significant ( < 0.0001). The mean number of trials was 1.27 ± 0.46 and 1.00 ± 0.00 for groups ST and FGPDT, respectively. It was statistically higher in group ST ( = 0.016). There was a significant reduction in the incidence of minor bleeding (oozing requiring dressing change, no need for transfusion or surgical intervention) with the FGPDT technique compared with ST [one patient (5%) and six patients (30%), respectively, < 0.005].
Conclusion
Bedside percutaneous tracheostomy with fiberoptic bronchoscopic guidance is safe and cost-effective. FGPDT reduces the overall incidence of wound infection and relevant bleeding when compared with ST. FGPDT may be considered the procedure of choice for performing elective tracheostomies in ICU ventilated patients.