human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background  Percutaneous dilational tracheostomy ( PDT )  can be performed under either conventional bronchoscopic or videobronchoscopic guidance . Only the latter procedure provides the surgeon with direct visual information . This study prospect ively assessed procedural parameters and complications of PDT guided by conventional bronchoscopy ( CB ) or videobronchoscopy ( VB ) . Methods Consecutive intensive care unit ( ICU ) patients who underwent PDT were enrolled in this study .  Videobronchoscopy was available in two ICUs , whereas CB was available in three ICUs . Demographic data , procedural variables , and complications were recorded . Results In this study , 36 patients underwent PDT guided by VB ( group V ) , and 38 patients underwent PDT guided by CB ( group C ) . The two groups were well matched in terms of gender , anatomic aspects , and positioning of the patient . Operating time , procedural difficulty , and extent of tracheal bleeding were not different between the two groups . Group V showed a tendency to younger age ( p = 0.055 ) . Surgeons significantly more often considered PTD to be “ completely safe ” in group V ( 92 % vs 61 % in group C ) . The skin incisions were smaller ( p = 0.003 ) , and the extent of stomal bleeding was less ( p = 0.001 ) . Complications were tendentiously less frequent in group V ( 5.5 % ) than in group C ( 23.7 % ; p = 0.062 ) . Conclusions The surgeon performing PDT guided by VB has a higher degree of safety , result ing in less bleeding than with PDT guided by CB Objective : To compare the safety , availability , and long-term sequelae of percutaneous vs. surgical tracheostomy . Design : Prospect i ve , r and omized , controlled study . Setting : Combined medical/surgical intensive care unit in a tertiary referral hospital . Patients : Two hundred critically ill mechanically ventilated patients who required tracheostomy .  Interventions : Tracheostomy by either percutaneous tracheostomy or surgical tracheostomy performed in the intensive care unit . Measurements and Main Results : The primary outcome measure was the aggregate incidence of predefined moderate or severe complications . The secondary outcome measures were the incidence of each of the components of the primary outcome . Long-term follow-up included clinical assessment , flow volume loops , and bronchoscopy .  Both groups were well matched for age , gender , admission Acute Physiology and Chronic Health Evaluation II score , period of endotracheal intubation , reason for intubation , and admission diagnosis . There was no statistical difference between groups for the primary outcome . Bleeding requiring surgical intervention occurred in three percutaneous tracheostomy patients and in no surgical tracheostomy patient ( p = .2 ) . Postoperative infection ( p = .044 ) and cosmetic sequelae ( p = .08 ) were more common in surgical tracheostomy patients . There was a shorter delay from r and omization to percutaneous tracheostomy vs. surgical tracheostomy ( p = .006 ) . Long-term follow-up revealed no complications in either group . Conclusions : Both percutaneous tracheostomies and surgical tracheostomies can be safely performed at the bedside by experienced , skilled practitioners OBJECTIVE To compare the safety and efficacy of percutaneous dilational tracheostomy ( PDT ) with surgical tracheostomy ( ST ) . DESIGN Prospect i ve r and omized trial . SETTING Public urban teaching hospital . PATIENTS Twenty-six patients were r and omized to undergo PDT and 27 patients to ST .  RESULTS The time from r and omization into the study until tracheostomy was performed was 28.5 + /- 27.9 h in the PDT group and 100.4 + /- 95.0 h in the ST group ( p < 0.001 ) . PDT was performed in 8.2 + /- 4.9 min vs 33.9 + /- 14.0 min for ST ( p < 0.0001 ) . There was no significant difference in intraprocedural complications between the groups . Postprocedural complication rates were 12 % for PDT and 41 % for ST ( p = 0.008 ) . CONCLUSION PDT is superior to ST logistically . PDT can be performed at the bedside eliminating the risk of patient transport . Because operating room scheduling is not necessary , PDT can be performed earlier once the decision to do a tracheostomy is made , which will improve ICU utilization . PDT is a faster procedure to perform and has fewer postprocedural complications Objective To determine the relative cost-effectiveness of percutaneous dilational tracheostomy ( PDT ) and surgical tracheostomy ( ST ) in critically ill patients . Design Prospect i ve r and omized study . Setting Medical , surgical , and coronary intensive care units at Barnes-Jewish Hospital , a tertiary care medical center . Patients Eighty critically ill mechanically ventilated patients requiring elective tracheostomy . Interventions R and omization to either PDT performed in the intensive care unit or ST performed in the operating room . Measurements and Main Results Treatment groups were well matched with respect to age ( PDT , 65.44 ± 2.82 [ mean ± se ] years ; ST , 61.4 ± 2.89 years , p = Ns ) , gender ( PDT , 45 % males ; ST , 47.5 % males , p = NS ) , severity of illness ( Acute Physiology and Chronic Health Evaluation II score : PDT , 16.87 ± 0.84 ; ST , 17.88 ± 0.92 , p = NS ) , and principle diagnosis . PDT was performed more quickly ( PDT , 20.1 ± 2.0 mins ; ST , 41.7 ± 3.9 mins , p < .0001 ) and was associated with lower patient charges than ST ( total patient charges : PDT , $ 1,569 ± $ 157 vs. ST , $ 3,172 ± $ 114 ; equipment/supply charges : PDT , $ 688 ± $ 103 vs. ST , $ 1,526 ± $ 87 ; professional charges : PDT , $ 880 ± $ 54 vs. ST , $ 1,647 ± $ 50;p < .0001 for all ) . There were no differences in days intubated before tracheostomy ( PDT , 12.7 ± 1.1 days ; ST , 15.6 ± 1.9 , p = .20 ) , intensive care unit length of stay ( PDT , 24.5 ± 2.5 days ; ST , 28.5 ± 3.1 days , p = .33 ) , or hospital length of stay ( PDT 49.7 ± 4.2 days ; ST , 43.7 ± 3.5 days , p = .28 ) when we compared these two techniques . Conclusions PDT is a cost-effective alternative to ST . The reduction in patient charges  associated with PDT in this study result ed from the procedure being performed in the intensive care unit , thus eliminating the need for operating room facilities and personnel . PDT may become the procedure of choice for electively establishing tracheostomy in the appropriately selected patient who requires long-term mechanical ventilation The aim of our study was to compare the complication rate of convenional surgical and percutaneous dilational tracheostomies performed under general anaesthesia in critically ill patients . Fifty-three consecutive patients whose lungs were mechanically ventilated and who required tracheostomy were r and omised to undergo either conventional surgical tracheostomy ( n = 28 ) in the operating room or percutaneous dilational tracheostomy ( n = 25 ) in the intensive care unit under general anaesthesia . All of the procedures were successfully completed . No deaths were related to the performance of either tracheostomy technique . Three patients in each group required a dressing change for minor bleeding at the tracheostomy site . There was no major bleeding requiring blood transfusion . One patient in each group developed atelectasis detected on chest x-ray postoperatively . In the surgical tracheostomy group , there were two patients with cuff leaks , one with a stomal infection and one with a pneumothorax . None of these complications occurred after percutaneous , dilational tracheostomy . We conclude that the low incidence of complications in both groups indicates that percutaneous dilational tracheostomy can be performed as safely in the intensive care unit with general anaesthesia as surgical tracheostomy can be performed in the operating room . RésuméNous comparons l’incidence des complications causées par la trachéotomie chirurgicale traditionnelle avec celles de la trachéotomie percutanée par dilatation réalisées sous anesthésie générate chez des gr and s malades . Cinquante-trois patients consécutifs sous ventilation mécanique do nt l’état nécessitait une trachéotomie sous anesthésie générate sont répartis pour subir soit une trachéotomie chirurgicale traditionnelle ( n = 28 ) en salle d’opération , soit une trachéotomie percutanée par dilatation ( n = 25 ) a l’unité des soins intensifs . Toutes les interventions ont été complétées avec succès . Aucun décès en rapport avec une ou l’autre des méihodes n’est survenu . Dans les deux groupes , on a du changer le pansement de trois patients pour un saignement mineur du site de la trachéotomie . Il n’y a pas eu de saignement majeur nécessitant de transfusions . Dans chaque groupe , on a détecté de l’atélectasie à la radiographie postopératoire . Dans le groupe de la trachéotomie chirurgicale , deux patients ont présenté des fuites au niveau du ballonnet de la canule , un patient a présenté une infection du stoma et un autre a présenté un pneumothorax . Ces complications ne sont pas survenue avec la méthode percutanée . L’incidence faible de complications dans les deux groupes montre que la trachéotomie percutanée peut être réalisée aussi bien à l’unité des soins intensifs sous anesthésie générate que la trachéotomie chirurgicale en salle d’opération OBJECTIVES Objectives of the study were 1 ) to analyze the complication incidence and re source utilization of two methods of bedside tracheostomy and 2 ) to define selection criteria for bedside tracheostomy . STUDY DESIGN Prospect i ve r and omized trial in the setting of a tertiary care center at a university hospital . METHODS One hundred sixty-four consecutive intubated patients selected for elective tracheostomy were enrolled . One hundred patients met selection criteria for bedside tracheostomy  and were r and omly assigned to either open surgical tracheostomy ( 50 ) or endoscopically guided percutaneous dilational tracheotomy(50 ) . The remaining 64 patients received open surgical tracheostomies in the operating room . Main outcome measures were 1 ) perioperative and postoperative complication incidence and 2 ) re source utilization . RESULTS Patients meeting our selection criteria for bedside tracheostomy had a significantly reduced perioperative complication rate compared with those who failed to meet these criteria , and subsequently underwent tracheostomy placement in the operating room ( 5 % vs. 20 % , P less than or equal to.01 ) . No statistically significant difference was found in the perioperative complication incidence between the two methods of bedside tracheostomy . However , percutaneous tracheostomy placement at the bedside result ed in a significant increase in postoperative complication incidence ( 16 % vs. 2 % , P < .05 ) and incurred an additional patient charge of $ 436 per bedside procedure . CONCLUSIONS This investigation prospect ively confirms the safety of bedside tracheostomy placement in properly selected patients .  Complication incidence and re source utilization are defined for two methods of bedside tracheostomy . The results of this study confirm that open surgical tracheostomy represents the st and ard of care in bedside tracheostomy placement by providing a more secure airway at a markedly reduced patient charge . These findings will aid in the development of protocol s and pathways for surgical airway management in critically ill patients to maximize cost-effective , high- quality care Objective : Percutaneous dilational tracheostomy ( PDT ) is increasingly used in intensive care units ( ICU ) , and it has a low incidence of complications . The aim of this study was to compare the costs , complications , and time consumption of PDT with that of conventional surgical tracheostomy ( ST ) when both procedures were performed in the ICU . Design : The study was a prospect i ve , r and omized trial . Setting : The procedures were performed routinely in the ICU of Satakunta Central Hospital . Patients : During a 23‐month period from December 1995 to November 1997 , 30 patients underwent PDT and 26 patients had ST .  In one patient , PDT was converted to ST .  All patients were receiving ventilation in the ICU , and all tracheostomies were performed at the patient 's bedside in the ICU . The Portex percutaneous tracheostomy kit was used for all PDTs . Results : The mean time to perform PDT was 11 mins ( SD , 6 ; range , 2‐40 ) , and the mean time to perform ST was 14 mins ( SD , 6 ; range , 3‐39 ) . In the PDT group , five patients had moderate bleeding during the procedure . In three patients , the bleeding was resolved with compression ; in one patient , it was resolved with ligation of the vessel ; and in one patient , it was resolved with electrocoagulation . Bleeding did not cause any complications afterward . In the PDT group , one patient had minimal oozing from the wound edge on the 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background  Percutaneous dilational tracheostomy ( PDT )  can be performed under either conventional bronchoscopic or videobronchoscopic guidance . Only the latter procedure provides the surgeon with direct visual information . This study prospect ively assessed procedural parameters and complications of PDT guided by conventional bronchoscopy ( CB ) or videobronchoscopy ( VB ) . Methods Consecutive intensive care unit ( ICU ) patients who underwent PDT were enrolled in this study .  Videobronchoscopy was available in two ICUs , whereas CB was available in three ICUs . Demographic data , procedural variables , and complications were recorded . Results In this study , 36 patients underwent PDT guided by VB ( group V ) , and 38 patients underwent PDT guided by CB ( group C ) . The two groups were well matched in terms of gender , anatomic aspects , and positioning of the patient . Operating time , procedural difficulty , and extent of tracheal bleeding were not different between the two groups . Group V showed a tendency to younger age ( p = 0.055 ) . Surgeons significantly more often considered PTD to be “ completely safe ” in group V ( 92 % vs 61 % in group C ) . The skin incisions were smaller ( p = 0.003 ) , and the extent of stomal bleeding was less ( p = 0.001 ) . Complications were tendentiously less frequent in group V ( 5.5 % ) than in group C ( 23.7 % ; p = 0.062 ) . Conclusions The surgeon performing PDT guided by VB has a higher degree of safety , result ing in less bleeding than with PDT guided by CB Objective : To compare the safety , availability , and long-term sequelae of percutaneous vs. surgical tracheostomy . Design : Prospect i ve , r and omized , controlled study . Setting : Combined medical/surgical intensive care unit in a tertiary referral hospital . Patients : Two hundred critically ill mechanically ventilated patients who required tracheostomy .  Interventions : Tracheostomy by either percutaneous tracheostomy or surgical tracheostomy performed in the intensive care unit . Measurements and Main Results : The primary outcome measure was the aggregate incidence of predefined moderate or severe complications . The secondary outcome measures were the incidence of each of the components of the primary outcome . Long-term follow-up included clinical assessment , flow volume loops , and bronchoscopy .  Both groups were well matched for age , gender , admission Acute Physiology and Chronic Health Evaluation II score , period of endotracheal intubation , reason for intubation , and admission diagnosis . There was no statistical difference between groups for the primary outcome . Bleeding requiring surgical intervention occurred in three percutaneous tracheostomy patients and in no surgical tracheostomy patient ( p = .2 ) . Postoperative infection ( p = .044 ) and cosmetic sequelae ( p = .08 ) were more common in surgical tracheostomy patients . There was a shorter delay from r and omization to percutaneous tracheostomy vs. surgical tracheostomy ( p = .006 ) . Long-term follow-up revealed no complications in either group . Conclusions : Both percutaneous tracheostomies and surgical tracheostomies can be safely performed at the bedside by experienced , skilled practitioners OBJECTIVE To compare the safety and efficacy of percutaneous dilational tracheostomy ( PDT ) with surgical tracheostomy ( ST ) . DESIGN Prospect i ve r and omized trial . SETTING Public urban teaching hospital . PATIENTS Twenty-six patients were r and omized to undergo PDT and 27 patients to ST .  RESULTS The time from r and omization into the study until tracheostomy was performed was 28.5 + /- 27.9 h in the PDT group and 100.4 + /- 95.0 h in the ST group ( p < 0.001 ) . PDT was performed in 8.2 + /- 4.9 min vs 33.9 + /- 14.0 min for ST ( p < 0.0001 ) . There was no significant difference in intraprocedural complications between the groups . Postprocedural complication rates were 12 % for PDT and 41 % for ST ( p = 0.008 ) . CONCLUSION PDT is superior to ST logistically . PDT can be performed at the bedside eliminating the risk of patient transport . Because operating room scheduling is not necessary , PDT can be performed earlier once the decision to do a tracheostomy is made , which will improve ICU utilization . PDT is a faster procedure to perform and has fewer postprocedural complications Objective To determine the relative cost-effectiveness of percutaneous dilational tracheostomy ( PDT ) and surgical tracheostomy ( ST ) in critically ill patients . Design Prospect i ve r and omized study . Setting Medical , surgical , and coronary intensive care units at Barnes-Jewish Hospital , a tertiary care medical center . Patients Eighty critically ill mechanically ventilated patients requiring elective tracheostomy . Interventions R and omization to either PDT performed in the intensive care unit or ST performed in the operating room . Measurements and Main Results Treatment groups were well matched with respect to age ( PDT , 65.44 ± 2.82 [ mean ± se ] years ; ST , 61.4 ± 2.89 years , p = Ns ) , gender ( PDT , 45 % males ; ST , 47.5 % males , p = NS ) , severity of illness ( Acute Physiology and Chronic Health Evaluation II score : PDT , 16.87 ± 0.84 ; ST , 17.88 ± 0.92 , p = NS ) , and principle diagnosis . PDT was performed more quickly ( PDT , 20.1 ± 2.0 mins ; ST , 41.7 ± 3.9 mins , p < .0001 ) and was associated with lower patient charges than ST ( total patient charges : PDT , $ 1,569 ± $ 157 vs. ST , $ 3,172 ± $ 114 ; equipment/supply charges : PDT , $ 688 ± $ 103 vs. ST , $ 1,526 ± $ 87 ; professional charges : PDT , $ 880 ± $ 54 vs. ST , $ 1,647 ± $ 50;p < .0001 for all ) . There were no differences in days intubated before tracheostomy ( PDT , 12.7 ± 1.1 days ; ST , 15.6 ± 1.9 , p = .20 ) , intensive care unit length of stay ( PDT , 24.5 ± 2.5 days ; ST , 28.5 ± 3.1 days , p = .33 ) , or hospital length of stay ( PDT 49.7 ± 4.2 days ; ST , 43.7 ± 3.5 days , p = .28 ) when we compared these two techniques . Conclusions PDT is a cost-effective alternative to ST . The reduction in patient charges  associated with PDT in this study result ed from the procedure being performed in the intensive care unit , thus eliminating the need for operating room facilities and personnel . PDT may become the procedure of choice for electively establishing tracheostomy in the appropriately selected patient who requires long-term mechanical ventilation The aim of our study was to compare the complication rate of convenional surgical and percutaneous dilational tracheostomies performed under general anaesthesia in critically ill patients . Fifty-three consecutive patients whose lungs were mechanically ventilated and who required tracheostomy were r and omised to undergo either conventional surgical tracheostomy ( n = 28 ) in the operating room or percutaneous dilational tracheostomy ( n = 25 ) in the intensive care unit under general anaesthesia . All of the procedures were successfully completed . No deaths were related to the performance of either tracheostomy technique . Three patients in each group required a dressing change for minor bleeding at the tracheostomy site . There was no major bleeding requiring blood transfusion . One patient in each group developed atelectasis detected on chest x-ray postoperatively . In the surgical tracheostomy group , there were two patients with cuff leaks , one with a stomal infection and one with a pneumothorax . None of these complications occurred after percutaneous , dilational tracheostomy . We conclude that the low incidence of complications in both groups indicates that percutaneous dilational tracheostomy can be performed as safely in the intensive care unit with general anaesthesia as surgical tracheostomy can be performed in the operating room . RésuméNous comparons l’incidence des complications causées par la trachéotomie chirurgicale traditionnelle avec celles de la trachéotomie percutanée par dilatation réalisées sous anesthésie générate chez des gr and s malades . Cinquante-trois patients consécutifs sous ventilation mécanique do nt l’état nécessitait une trachéotomie sous anesthésie générate sont répartis pour subir soit une trachéotomie chirurgicale traditionnelle ( n = 28 ) en salle d’opération , soit une trachéotomie percutanée par dilatation ( n = 25 ) a l’unité des soins intensifs . Toutes les interventions ont été complétées avec succès . Aucun décès en rapport avec une ou l’autre des méihodes n’est survenu . Dans les deux groupes , on a du changer le pansement de trois patients pour un saignement mineur du site de la trachéotomie . Il n’y a pas eu de saignement majeur nécessitant de transfusions . Dans chaque groupe , on a détecté de l’atélectasie à la radiographie postopératoire . Dans le groupe de la trachéotomie chirurgicale , deux patients ont présenté des fuites au niveau du ballonnet de la canule , un patient a présenté une infection du stoma et un autre a présenté un pneumothorax . Ces complications ne sont pas survenue avec la méthode percutanée . L’incidence faible de complications dans les deux groupes montre que la trachéotomie percutanée peut être réalisée aussi bien à l’unité des soins intensifs sous anesthésie générate que la trachéotomie chirurgicale en salle d’opération OBJECTIVES Objectives of the study were 1 ) to analyze the complication incidence and re source utilization of two methods of bedside tracheostomy and 2 ) to define selection criteria for bedside tracheostomy . STUDY DESIGN Prospect i ve r and omized trial in the setting of a tertiary care center at a university hospital . METHODS One hundred sixty-four consecutive intubated patients selected for elective tracheostomy were enrolled . One hundred patients met selection criteria for bedside tracheostomy  and were r and omly assigned to either open surgical tracheostomy ( 50 ) or endoscopically guided percutaneous dilational tracheotomy(50 ) . The remaining 64 patients received open surgical tracheostomies in the operating room . Main outcome measures were 1 ) perioperative and postoperative complication incidence and 2 ) re source utilization . RESULTS Patients meeting our selection criteria for bedside tracheostomy had a significantly reduced perioperative complication rate compared with those who failed to meet these criteria , and subsequently underwent tracheostomy placement in the operating room ( 5 % vs. 20 % , P less than or equal to.01 ) . No statistically significant difference was found in the perioperative complication incidence between the two methods of bedside tracheostomy . However , percutaneous tracheostomy placement at the bedside result ed in a significant increase in postoperative complication incidence ( 16 % vs. 2 % , P < .05 ) and incurred an additional patient charge of $ 436 per bedside procedure . CONCLUSIONS This investigation prospect ively confirms the safety of bedside tracheostomy placement in properly selected patients .  Complication incidence and re source utilization are defined for two methods of bedside tracheostomy . The results of this study confirm that open surgical tracheostomy represents the st and ard of care in bedside tracheostomy placement by providing a more secure airway at a markedly reduced patient charge . These findings will aid in the development of protocol s and pathways for surgical airway management in critically ill patients to maximize cost-effective , high- quality care Objective : Percutaneous dilational tracheostomy ( PDT ) is increasingly used in intensive care units ( ICU ) , and it has a low incidence of complications . The aim of this study was to compare the costs , complications , and time consumption of PDT with that of conventional surgical tracheostomy ( ST ) when both procedures were performed in the ICU . Design : The study was a prospect i ve , r and omized trial . Setting : The procedures were performed routinely in the ICU of Satakunta Central Hospital . Patients : During a 23‐month period from December 1995 to November 1997 , 30 patients underwent PDT and 26 patients had ST .  In one patient , PDT was converted to ST .  All patients were receiving ventilation in the ICU , and all tracheostomies were performed at the patient 's bedside in the ICU . The Portex percutaneous tracheostomy kit was used for all PDTs . Results : The mean time to perform PDT was 11 mins ( SD , 6 ; range , 2‐40 ) , and the mean time to perform ST was 14 mins ( SD , 6 ; range , 3‐39 ) . In the PDT group , five patients had moderate bleeding during the procedure . In three patients , the bleeding was resolved with compression ; in one patient , it was resolved with ligation of the vessel ; and in one patient , it was resolved with electrocoagulation . Bleeding did not cause any complications afterward . In the PDT group , one patient had minimal oozing from the wound edge on the 
    Output:
    