Percutaneous tracheostomy: A clinical comparison of dilatational (Ciaglia)and translaryngeal (Fantoni) techniques

A number of percutaneous procedures for tracheostomy have been established within the last few years, among them a new technique by Fantoni using a tr anslaryngeal approach for cannula placement. To compare the new translaryng eal tracheostomy (TLT) to the common percutaneous dilatational technique (P DT), we prospectively studied 90 patients who required elective tracheostom y. Tracheostomy was performed according to either the Ciaglia or the Fanton i technique in 45 patients at bedside. The overall complication rate was 11 .1% (n = 5) in PDT, Including aspiration of blood (n = 4) and severe bleedi ng requiring surgical intervention (n = 1). During TLT, there were technica l difficulties involving guidewire placement in 31.1% (n = 14), and one pat ient required conversion to PDT. No other complications were noted in TLT. Regardless of the technique used, the postoperative PaO2/FIO2 ratio was sli ghtly lower than preoperatively (P was not significant). When PDT and TLT w ere compared, the postoperative PaO2/FIO2, ratio was significantly lower in PDT than in TLT (P < 0.05), whereas the preoperative levels did not vary s ignificantly between PDT and TLT. During TLT, the Pace, increased significa ntly, whereas it remained stable throughout PDT. No infection of the trache ostoma was noted in either the PDT or the TLT. We therefore consider both t he PDT and the TLT equally safe and attractive techniques for establishing long-term airway access in critically ill patients. Implications: Elective tracheostomy is a widely accepted procedure for gaining long-term airway ac cess. Two techniques for percutaneous tracheostomy-the established Ciaglia method and the new translaryngeal Fantoni technique-were prospectively stud ied for perioperative complications and practicability in 90 critically ill -patients.