Impact of percutaneous tracheostomy implementation in the Adult-ICU at the University Hospital of Neiva

Abstract

Objective: Open tracheostomy (OT) and percutaneous tracheostomy (PT) are frequent procedures in mechanically ventilated patients in Intensive Care Unit (ICU). Several publications have compared both techniques and their complications, especially in developed countries. This study aims to identify the characteristics of the OT and PT procedures, analyzing their complications in an ICU population of a university hospital in a developing country.  Materials and Methods: in the adult ICU in Neiva University Hospital (NUH), 66 OT and 46 PT were performed in a 21-month and 6-month period, respectively. These two retrospective cohorts were analyzed, including demographic and causal factors, request reasons, accomplishment times. Early complications and mortality were also analyzed. Results: The incidence of PT was 12.5% compared with 9% of OT. Early tracheostomy (first 10 days of orotracheal intubation), was more frequent percutaneously (OT:70%, PT: 96%). Early complications were 2.9 times more common in OT patients compared with PT (p:0.00015). Bleeding was the main complication in both techniques, being 4.7 times greater in OT compared with PT (p: 0.0022). The infection rate of surgical site was 5.6 times greater in OT than in PT (p: 0.0009). There was no association between the coagulation times as a risk factor and postsurgical bleeding. Complications like false route and pneuromathorax were present only in the PT group and were immediately solved by the surgeon in charge of the case. There was no mortality related to the procedure in any case. Conclusions: during the analysis of OT and PT carried out in the Adult ICU of the NUH, complications like bleeding and infection at the operatory site were minimal in the PT group compared with OT. PT was carried out earlier and in less time compared with OT which implies improvement in the opportunity of its performance.