PERCUTANEOUS DILATIONAL TRACHEOSTOMY - A CLINICAL-STUDY EVALUATING 2 SYSTEMS

Percutaneous dilational tracheostomy (PDT), first described in the 195 0s, has become a common bedside technique in the Intensive Care Unit ( ICU), This study compares the early complications associated with the use of the Ciaglia PDT (Cook Critical Care, Bloomington, USA) techniqu e, with the newly available Porter PDT technique (Porter Ltd., UK). Th e Ciaglia technique was adopted in this ICU in July 1994 and twenty-ni ne patients had a tracheostomy using this set until January 1995. Comp lications during the procedure were collected prospectively. When the Porter PDT set became available in January 1995, it was decided to ass ess the complication rate of this technique and compare them to the pr eviously-collected data using the Ciaglia PDT set. Twenty-five patient s have had a tracheostomy using the Porter PDT set. There has been no mortality associated with either PDT set. Bleeding requiring intervent ion occurred in two patients in the Ciaglia group and three patients i n the Porter Group. All these patients had a bleeding diathesis. Loss of airway control occurred on one occasion in the Ciaglia group due to premature removal of the endotracheal tube. The first routine tracheo stomy tube change at day 7 was complicated in four cases in the Ciagli a group. One infected stoma was noted in the Ciaglia group at day 7. B oth techniques result in rapid, safe placement of a tracheostomy tube in critically ill patients in the ICU, obviating the need for surgical referral and transport to the operating room.