Abstract

MARRUECOS-SANT, L.  and  GRUPO DE TRABAJO DEL PROTOCOLO INSTITUCIONAL DE TRAQUEOTOMIAS DEL HOSPITAL DE LA SANTA CREU I SANT PAU et al. Percutaneous tracheotomy and cricothyroidotomy in the critical patient. Med. Intensiva [online]. 2009, vol.33, n.3, pp.109-114. ISSN 0210-5691.

Objective. To review and compare the complications of percutaneous tracheotomy (TP) and cricothyroidotomy (CT) used to perform tracheal intubation in patients requiring prolonged mechanical ventilation. Design. A prospective, observational study performed from October 2004 to October 2006, and follow-up of course until May 2007. Setting. Intensive care service from a university-affiliated teaching hospital. Patients. A total of 82 patients in which CT or TP were necessary. Forty-three TP and 39 CT were performed. Main measurements. Reason 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. Results. TP/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. Conclusions. In our experience CT constitutes a safety and feasible alternative to TP when TP is counter-indicated.

Keywords : Tracheotomy; Cricothyroidotomy; Percutaneous tracheotomy.

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