[The application of a small incision combined with improved percutaneous tracheostomy in difficult tracheostomy].

OBJECTIVE: To describe an improved percutaneous tracheostomy combined with conventional tracheostomy technique with result of less trauma and fewer complications, and to explore its application in the patients for whom conventional tracheostomy is difficult to perform.

METHODS: A prospective study was conducted. Fifty-seven hospitalized patients, in whom ordinal tracheostomy was difficult to perform, and admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Bengbu Medical College from January 2013 to December 2014 were enrolled. According to the random digital table method, the patients were divided into small incision combined with percutaneous tracheostomy group (small puncture incision group, n = 25) and conventional tracheostomy group (n = 32). Amount of blood loss, postoperative bleeding, incision size, operation time and wound healing time were compared between the groups.

RESULTS: Compared with traditional surgical tracheostomy group, the blood loss and postoperative bleeding were decreased [blood loss (mL): 11.36 ± 4.25 vs. 23.72 ± 7.29, t = -7.201, P = 0.000; postoperative bleeding (mL): 11.60 ± 6.57 vs. 26.77 ± 10.77, t = -5.834, P = 0.000 ], incision size was smaller (cm: 2.20 ± 0.63 vs. 4.06 ± 1.19, t = -6.806, P = 0.000), and operation time and wound healing time were shortened [operative time (minutes): 18.16 3.61 vs. 29.09 ± 6.77, t = -7.001, P = 0.000; incision healing time (days): 4.96 ± 1.59 vs. 7.19 ± 2.35, t = -3.975, P = 0.000] in small puncture incision group.

CONCLUSION: Compared with the traditional method, small incision puncture tracheostomy is less time consuming, with fewer traumas, and fewer intraoperative and postoperative complications.