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Method: Thirty patients (19M/11F) were enrolled in the study period from 2004-2005. Informed consent was obtained from all patients (or from the next of kin). 15 patients (8M/7F, mean age 76 ± 8.4) were scheduled for Fantoni PDT and 15 patients (11M/4F, mean age 71 ± 4.4) for PercuTwist PDT in the ICU, exclusion criteria being prior tracheostomy, major coagulation disorders, purulent airway secretions and active airway bleeding. All patients were fasted for at least 6 hours prior to intervention and anaesthesia. Muscle relaxation and analgesia were provided in a standardized manner to all patients. Flexible (PercuTwist) or rigid (Fantoni) bronchoscopy was provided in all patients. The endotracheal tube was substituted by a laryngeal mask airway (LMA) in all PercuTwist procedures. Intervention times, respiratory and haemodynamic parameters, blood losses and early (within 48 hours) and late complications were recorded. Data were expressed as mean values ± standard deviation (SD), variables were compared by two-tailed Student's t-test. P < 0.01 was considered statistically significant.
Results: Procedure duration was similar in both groups and respiratory and haemodynamic parameters remained equally stable. Blood losses were significantly different between groups (3 cases of intra-procedural haemorrhage in the PercuTwist group, P < 0.01; one PercuTwist procedure had to be switched to a surgical tracheostomy). In four cases of the Fantoni group minor difficulties in final positioning of the tracheal cannula were observed (26.7%, P <0.01). Late complications included in the PercuTwist group were 1 tracheal stenosis and 1 case of refractory sialorrhoea (incidence of late complications 13.3%, P < 0.01). No other major complications and no procedural related deaths were observed.
Discussion: Both techniques may offer specific advantages in certain patient groups [2]. In our study the incidence of procedural bleeding and of late complications were higher in the PercuTwist group, minor procedure difficulties were more frequent in the Fantoni group. We conclude that the Fantoni PDT offers a better risk protection against tracheal wall damage than the PercuTwist PDT.
