Percutaneous dilatational tracheostomy versus standard tracheostomy: Pro standard tracheostomy

Any type of tracheostomy should be performed by physicians committed to airway management procedures. A consummate knowledge of anatomy and the ability to manage emergent complications is required. The standard tracheostomy is performed by personnel who routinely meet these requirements. It can be established through the proper ring in every case. Posterior tracheal injury should not occur, and intraprocedural hemorrhage can be managed immediately by the surgeon. If one chooses, it can be performed under local anesthesia in the ICU without the expense of the disposable kit or bronchoscopy. Standard tracheostomy should still be considered the procedure of choice. Certainly the fine results reported in the literature concerning percutaneous dilatational tracheostomy represent the best that can be accomplished by committed personnel who can generate reasonably large series. Whether these results can be translated into a setting where far fewer cases need to be performed remains to be proven. Surgeons who perform tracheostomy in the operating room should review the available data and work in concert with their institution to provide the safest most cost-effective care possible.