Percutaneous dilational and surgical tracheostomy in burn patients: incidence of complications and dysphagia.

The aim of this study is to evaluate the incidence of complications and dysphagia in relation to the timing of tracheostomy and tracheostomy technique in 49 consecutive adult burn patients. We analysed prospectively collected data. Bronchoscopy was used to diagnose tracheal stenosis and a modified Evans blue dye test was used to diagnose dysphagia. Eighteen patients received a percutaneous dilatational tracheostomy (PDT) and thirty-one patients received an open surgical tracheostomy (OST). Eight patients developed significant complications (16%) following tracheostomy, there is no difference in the incidence of complications; post op infection, stoma infection or tracheal stenosis between PDT and OST groups. Patients with full thickness neck burn who developed complications had a tracheostomy significantly earlier following autografting (p=0.05). Failed extubation is associated with dysphagia (p=0.02) whereas prolonged intubation and ventilation prior to tracheostomy independently predicts dysphagia (p=0.03). We conclude that there is no difference in the complication rates for PDT and OST in our burn patients. We recommend early closure of neck burns and tracheostomy through fully adherent autograft or at least 10 days after grafting to reduce stomal infections. For patients with no neck burn, we support early tracheostomy to reduce the likelihood of dysphagia.