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Percutaneous vs Surgical Tracheostomy — FRCA Final MCQ

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ModerateIntensive Care MedicinePercutaneous vs Surgical TracheostomyFRCA Final

A 65-year-old man on ICU has failed a spontaneous breathing trial. He has been ventilated for 18 days. He is considered for tracheostomy. Regarding percutaneous vs surgical tracheostomy, the Intensive Care Society recommends:

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Correct answer: D — Both techniques have similar complication rates; the choice depends on patient anatomy, operator expertise, and clinical circumstances

The ICS and NTSP guidelines state that both percutaneous dilational tracheostomy (PDT) and surgical tracheostomy have comparable complication and success rates. The choice depends on: (1) patient factors (neck anatomy – short/obese/landmarks, cervical spine pathology, previous neck surgery/radiotherapy), (2) operator expertise, (3) availability of surgical theatre vs bedside procedure. PDT is commonly performed at the bedside in ICU under bronchoscopic guidance. Surgical tracheostomy is preferred when: difficult anatomy, paediatric patients, or when tracheal pathology is suspected.

Reference: NTSP/DAS/ICS – 2023 – Tracheostomy guidelines; NCEPOD – 2014 – On the right trach?