Shamim Ahmed, Othman Habib, Kafil Ahmed, David Lee.
Percutaneous Dilatational Tracheostomy: time to practice in the third world?.
Pak J Surg Jan ;22(2):66-9.

Objective: To compare the technique of Per-Cutaneous Dilatational Tracheostomy (PCTD) with the conventional Open Tracheostomy (OT), and to evaluate its feasibility in the third world countries. The parameters compared were operative time, complications (early and late) and cost. Design & Duration: Prospective, comparative study carried out from Jan. 2002 to July 2003. Setting: Department of ENT, Military Hospital, Al-Hada, Taif, Saudi Arabia Patients: All patients who underwent tracheostomy during the study period. Methodology: The patients who needed tracheostomy were evaluated and randomly assigned to either of the techniques i.e. PTCD or OT and the results compared as regards to operative time, complications (early and late) and cost of the procedure. Results: A total of 115 patients, 75 males and 40 females with an age range of 17-90 years (mean 43.5 years) underwent tracheostomies. Fifty three patients were operated by the technique of PCDT with an average operating time of 13.9 minutes, whereas 62 cases underwent conventional OT with an average operating time of 31.7 minutes. Haemorrhage occured in three cases of PCDT as compared to five cases in OT. Wound infection was seen in two cases of PCDT and three cases of OT. All cases of OT were performed in the operation theatre, while only few initial cases of PCDT were done in the operation theatre. The actual kit of the latter is however quite expensive. Conclusion: PCDT is a safe, quicker and convenient procedure, with fewer complications, and can be performed at bedside. However, the price of the PCDT Kit is quite high, which may be the only hindrance in accepting this as a technique of choice in the third world countries.

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