OBJECTIVE: To evaluate the outcomes of percutaneous dilatational tracheostomy (PDT) versus surgical tracheostomy (ST) in critically ill patients, focusing on complications, duration of mechanical ventilation (MV), intensive care unit (ICU) length of stay, and mortality. DESIGN: Retrospective trial SETTING: Single tertiary center PARTICIPANTS: A total of 119 patients receiving invasive MV in a medical ICU INTERVENTIONS: PDT (n = 55) or ST (n = 64) methods MEASUREMENTS AND MAIN RESULTS: The 2 groups showed comparable outcomes in terms of MV duration (36 days for PDT vs 35 days for ST
p = 0.72), ICU stay (43 days for PDT vs 37 days for ST
p = 0.17), and all-cause mortality (71% for PDT vs 64% for ST
p = 0.42). PDT was associated with significantly lower rates of subcutaneous emphysema (0% vs 16%
p = 0.01). Multivariate analysis showed no statistically significant association between tracheostomy technique and ICU mortality or overall complication rates after adjustment for confounders. CONCLUSION: PDT and ST yield comparable outcomes in critically ill ICU patients, with no significant difference in overall complication rates or mortality. The fewer specific complications for PDT, such as subcutaneous emphysema, highlight its advantages in suitable cases. Individualized patient assessment remains crucial, and further studies are needed to refine tracheostomy practices.