• L Marruecos-Sant, L Zapata-Fenor, E Manero-Caballero, P Vera-Artázcoz, and Grupo de Trabajo del Protocolo Institucional de Traqueotomías del Hospital de la Santa Creui Sant Pau.
• Servicio de Medicina Intensiva. Hospital de la Santa Creu i Sant Pau. Barcelona. España. Lmarruecos@santpau.es
• Med Intensiva. 2009 Apr 1; 33 (3): 109-14.

ObjectiveTo review and compare the complications of percutaneous tracheotomy (TP) and cricothyroidotomy (CT) used to perform tracheal intubation in patients requiring prolonged mechanical ventilation.DesignA prospective, observational study performed from October 2004 to October 2006, and follow-up of course until May 2007.SettingIntensive care service from a university-affiliated teaching hospital.PatientsA total of 82 patients in which CT or TP were necessary. Forty-three TP and 39 CT were performed.Main MeasurementsReason for TP or CT, demographic data, severity scores, ICU length of stay, orotracheal intubation (OTI) days, CT/TP early and late complications and in-hospital evolution were collected.ResultsTP/CT were performed due to prolonged ventilation in 62 (76%) patients and because of impaired neurological status in the remaining patients. There were no differences between TP/CT in gender, APACHE II, ICU length of stay, previous OTI days. Patients in the CT group were older (68 +/- 9 vs 54 +/- 15 years, p < 0.001). There were 5 mild adverse events (3 guide angulations and 2 lateral tracheal punctions) after TP, and 1 severe adverse event (pulmonary ventilation problem) after CT. There were no fatal event related with TP/CT. Thirty-four patients were decanulated. Mild local injuries were seen in 8 patients (6 TP vs 2 CT). Only 1 subglottic granuloma was seen late in CT group.ConclusionsIn our experience CT constitutes a safety and feasible alternative to TP when TP is counter-indicated.

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