• S Muttini, G Melloni, M Gemma, A Casati, A Carretta, D Giudici, S Cozzi, G Chiesa, G Gallioli, L Beretta, E Casaletti, and G Torri.
• Servizio di Anestesia e Rianimazione, IRCCS H San Raffaele, Università degli Studi, Milano.
• Minerva Anestesiol. 1999 Jul 1; 65 (7-8): 521-7.

BackgroundTo compare early and late complications after either conventional surgical or percutaneous dilatational tracheostomy.DesignProspective, randomized study.SettingGeneral intensive care unit and neuro-surgical intensive care unit in a university hospital.Patients50 consecutive patients, requiring tracheostomy for prolonged mechanical ventilation.Interventions And MeasurementsPatients were randomly allocated to receive either surgical (surgical group, n = 25) or percutaneous dilatational tracheostomy (percutaneous group, n = 25). Occurrence of perioperative complication were carefully evaluated during ICU stay. Late complications were evaluated with both physical and endoscopic examination at 1, 3 to 6 months after tracheostomy.ResultsAll surgical and percutaneous tracheostomies were successfully completed and no deaths directly related to the tracheostomy procedures were reported. Completion of the procedure required 41 +/- 14 min in the surgical group and 14 +/- 6 min in the percutaneous one (p < 0.0001). The incidence of early perioperative complications was higher in the surgical group (36%) than in percutaneous one (12%), (p < 0.05). The endoscopic follow-up demonstrated one segmental malacia and one stenosis of the trachea in the percutaneous group only (p = n.s.). Skin repair was better after percutaneous tracheostomy than in the surgical group (p < 0.01).ConclusionsIn experienced hands, percutaneous dilatational tracheostomy is as safe and effective as the conventional surgical tracheostomy. The percutaneous technique is less time-consuming and has a lower rate of early infectious complications with better cosmetic results than the surgical technique.

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