Percutaneous tracheostomy may not be more effective than open technique

EDITOR—In his review of recent advances in intensive care Stott emphasised the efficacy of percutaneous tracheostomy over the conventional open surgical approach.1 We agree that percutaneous tracheostomy may indeed be the preferred method in selected cases, but it is invariably not used in patients who present anatomical challenges such as a short, thick neck; goitre; a history of neck surgery; or a concurrent coagulopathy. Such difficult cases probably represent about a quarter of an average population requiring tracheostomy.

We disagree with Stott's assertion that the incidence of complications has been shown to be lower with percutaneous tracheostomy than with open surgical techniques. The paper quoted in support of this statement—by Hill et al—describes the results of 356 percutaneous procedures performed in a single unit over four years.2 No direct comparison is made with open tracheostomies, and the authors do not report the numbers and type of patients deemed unsuitable for percutaneous tracheostomy and referred for open procedures. The six previous independent series quoted that detailed complication rates for open tracheostomy were published …