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Complications of Tracheostomy Performed in the ICU^*

Subthyroid Tracheostomy vs Surgical Cricothyroidotomy

^* From the Intensive Care Unit (Drs. François, Clavel, Desachy, Roustan, and Vignon) and the Ear Nose Throat Department (Dr. Puyraud), Dupuytren Teaching Hospital, Limoges, France.

Correspondence to: Bruno François, MD, Service de Réanimation Polyvalente, CHU Dupuytren, 2 Av Martin Luther King, 87042 Limoges Cedex, France; e-mail: realim{at}unilim.fr

Background: The morbidity of surgical tracheostomy performed in critically ill patients is not well-known. Accordingly, the aim of this prospective study was to determine the incidence and severity of complications associated with subthyroid tracheostomy and cricothyroidotomy when performed in the ICU.

Methods: Over a 2-year period, individual consecutive patients who were undergoing an elective tracheostomy were studied. Attending physicians elected the timing and technique of the tracheostomy. All procedures were performed at the bedside. A complete laryngeal examination was performed before ICU discharge, prior to decannulation, and 6 months after the tracheostomy.

Results: A tracheostomy (subthyroid, 86 patients; cricothyroidotomy, 32 patients) was performed in 118 of 1,574 patients (mean [± SD] age, 54 ± 18 years; 79 men, 39 women; mean APACHE [acute physiology and chronic health evaluation] II score, 19 ± 2). No deaths could be attributed to the tracheostomy procedure, and 40 complications occurred in 36 patients (30%), with a similar incidence in both groups (subthyroid group, 30 of 86 patients; cricothyroidotomy, 10 of 32 patients; p = 0.9). The severity and timing of complications were comparable between groups.

Conclusions: In the present series, the incidence and severity of complications associated with conventional subthyroid tracheostomy and surgical cricothyroidotomy performed in the ICU were similar. The bedside cricothyroidotomy, which is technically easier to perform, represents a valuable alternative to conventional tracheostomy in the management of critically ill patients.

Key Words: intensive care • postoperative complications • tracheostomy

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