What are the advantages and disadvantages of surgical or percutaneous tracheostomies?
Percutaneous
Surgical
Advantages
- Relatively quick in experienced hands
- Avoids need for transfer of unstable patients
- Does not require involvement of surgeons
- Cheaper
- Smaller scar
- Tighter stoma that decreases stomal bleeding and provides better fit
- Can be performed when percutaneous contraindicated:
- Short or thick neck, obese
- Coagulopathy
- Unstable spine
- Previous neck / thyroid surgery
- Abnormal vessels
- Resources available to control bleeding
- Potentially easier management in event of early tube dislodgment or tube exchange:
- Stoma stitched open
- May have stay sutures to elevate the trachea
Disadvantages
- Suboptimal conditions for management of bleeding, especially if major vessel injured
- Blind techniques can be incorrectly positioned
- Tracheal ring fracture can occur
- Late tracheal stenosis (as per surgical tracheostomy)
- Lack of surgical dissection can increase risk of vascular or thyroid injury
- Potentially more difficult management in event of early tube dislodgment or tube exchange:
- Tissues will tend to ‘spring’ closed when tube removed in first 7–10 days
- Requires operating theatre leading to delays in insertion
- Requires patient transfer
- More expensive