Comparing percutaneous tracheostomy with open surgical tracheostomy

Both will coexist until robust evidence becomes available

Tracheostomy is one of the most frequent surgical procedures carried out in critically ill patients.1 Traditionally, open surgical tracheostomy has been done by surgeons in the operating room, and in many institutions it remains that way. In the past 50 years, however, several methods of doing percutaneous tracheostomy at the bedside have been introduced. Some of these methods did not get far because of high complication rates. The most popular technique today is the percutaneous dilatational tracheostomy described by Ciaglia in 1985.2 This technique uses serial dilators over a guide wire and is usually done at the bedside in the intensive care unit under bronchoscopic guidance. Ciaglia later introduced a single tapered dilator to replace the serial dilators, further simplifying the technique. In experienced hands, percutaneous tracheostomy can be done in five to 10 minutes and will rarely require more than 15 minutes. The low cost of percutaneous tracheostomy initially was an important reason …