This document discusses a proposed study comparing dilatational percutaneous tracheostomy (PDT) to surgical tracheostomy. The study aims to show that PDT is less time consuming and has a lower rate of complications than surgical tracheostomy. It also aims to prove that PDT is more economical and will replace surgical tracheostomy in intensive care units. The document provides background on the history and types of tracheostomies. It outlines the hypothesis, aims, operational definitions, study design, sample size, inclusion/exclusion criteria, data collection and analysis process for the proposed study comparing PDT to surgical tracheostomy.

1. Dilatational Percutaneous tracheostomy v/s Surgical Tracheostomy DSAS. 2015
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“SYNPOSIS”
“DILATATIONAL PERCUTANEUOS TRACHEOSTOMY
AN S-ICU EXPERIENCE V/S SURGICAL
TRACHEOSTOMY”
or
PERCUTANEOUS DILATIONAL TRACHEOSTOMY V/S
SURGICAL TRACHEOSTOMY IN SICU.
PROFESSOR & HOD. DR IQBAL MEMON.
PROFESSOR & Incharge SICU. DR KAMAL NASIR
DR. S H WAQAR
DR SAIM ALI SOOMRO
DR Rakhshanda Jabeen.
Dr Fareeda Ali.
PAKISTAN INSTITUTE OF MEDICAL SCIENCES, ISLAMABAD.
2015.

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To,
The Honorable Chairman Ethical Committee,
SZABMU, PIMS, ISLAMABAD
RespectedMembers
We want to conduct a study titled “DILATATIONAL PERCUTANEUOS TRACHEOSTOMY.
AN S-ICU EXPERIENCE V/S SURGICAL TRACHEOSTOMY” or PERCUTANEOUS DILATIONAL
TRACHEOSTOMY V/S SURGICAL TRACHEOSTOMY IN SICU. Both are eligible titles, whichever is
proposed by Ethical Committee, we will start writing, most of the material is already collected.
We will be highly obliged for permission granted. This study is being supervised by Head of
Department Prof. Dr Mohammad Iqbal Memon, Prof. Dr Khwaja Kamal Nasir incharge Surgical
Intensive Care and Finally Dr Waqar Hussain. The Proposal in the shape of Synopsis is being
presented to your August Committee for fare approval.
Sincerely
Dr.S.H Waqar
Dr Saim Ali Soomro.
Dr Rakhshanda Jabeen.

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I. Introduction.
Tracheostomy is one of the oldest surgical procedure (1),its wonderful to know that its drawing
is found on an Egyptian tablet, its almost 3600 BC, Ascelepedias is first person to perform a
tracheotomy in 100BC, but the Parasovala was first person who has performed a success ful
Tracheostomy IN 15TH century but gUIDI was First person in 16th century to invent a successful
method to perform Tracheostomy .reports are found sporadically7 about tracheotomies in
Medical literature up to 18th century, but real material & documentation are found since 1th
century.in 1545 an Italian physician published his first account of tracheostomy successfully.
Fig1
This T
This rare image was taken from National Museum of medicine, By Guidi who first described the
structure of larynx and pharynx, associated Nerves & Blood vessels , beside describing a
successful method of Tracheostomy, it was initially named as Phyrangotomy, Laryngotomy,
Tracheostomy, tracheotomy.
Initially Tracheotomies were done to treat Upper airway obstruction in children, First & founder
President of USA George Washington was killed by an upper air way Obstruction may be
Epiglottis or an abscess.
I am one of the most senior worker in ICU when it was only and general intensive care , in 19 88

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Since than I have been associated with critical care off & On, It’s one of the most commonly
requested PROCEDURES in ICU which is Surgical way of doing Tracheostomy, but most
annoying thing is that we get very late till tracheostomy is done.
There are many type of Surgical ways to do Tracheostomy, recently we read and was
demonstrated percutaneous dilatational Tracheostomy at the bed side of Patient by AFIC in a
seminar, its easy asceptic, seldinger technique is used (FIG 2)
Serial dilatational percutaneous Tracheostomy.

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Tracheostomies are most frequently used techniques in ICU after CVP insertion ,Patient
needing prolonged Ventilation, Neuro-muscular disorders, Acute Head injury or selective
operational procedures in Brain, failure to wean in less than two weeks, one can manage low
volume High pressure tubes (Endo tracheal tubes). Main benefit is it can be on done bed side,
under local anesthetic & sedation while surgical Tracheostomy needs more time and efforts.
Mostly its performed on space between 3&4th Tracheal rings, in emergency another procedure
for temporarily use is Crico-thyrotomy, but with the ease of availability of dilatational
percutaneous kits and with time its prices going down it will replace surgical Tracheostomy in
all ICUs. We decided to do a study on surgical v/s percutaneous dilatational Tracheostomy. Four
types of incisions or flaps/ holes are made in Trachea when surgical Tracheostomy is done, it
depends on Surgeons choice or practice on a certain procedure. We will conduct study to
differentiate the procedures, complication rates and ease of procedure, there is no need to
manage or arrange an OT.
With the time & practice the duration of performing procedure is getting lesser, rate of
complication also lesser & lesser. With tie and practice many procedures are perfomed ICU ,
itself by Intensivist, like supra pubic Punctures, echocardiography, ventriculo-peritoneal tubes,
with time more and more procedures are getting ICU/ Intensivist, domains. ultra sound is also
one important specialty for an Intensivist.
II. Hypothesis:
ICUs will shortly replace surgicalTracheostomy by Percutaneous dilatational
Tracheotomies’ in next few years.
We will discuss in little detail our Hypothesis.
III. Aims & Objects.

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 Main aim is to prove worth of
Percutaneous dilatational Tracheostomy.
 Aim to prove less economical procedure.
 Less time consuming and lesser rate of
complications.
IV. OPERATIONAL DEFINITIONS.
 Tracheostomy:
 Tracheotomy v/s tracheostomy.
 SurgicalTracheostomy.
 Percutaneous dilatational Tracheostomy.
V. MATERIALS AND METHODS
A: *STUDY DESIGN
B: SETTINGS
C: *DURATION OF STUDY:
Within one month after approval .
SAMPLE SIZE:

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SAMPLE TECHNIQUE:
NON PROBABILITY.
SAMPLE SELECTION:
*INCLUSION CRITERIA
1.
2.
*EXCLUSION CRITERIA.
DATA COLLECTION PROCEDURE
 Main tool is Performa designed by a Senior Doctor.
 After obtaining consent frompatient, before procedureis conducted.
DATA ANALYSIS
 Is doneafter completion of study in somedetails.
 Discussion is donebetween surgicalv/s PCDT

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REFERENCES:
1. www.tracheostomy/history/index/