K. Westphal et al., Percutaneous tracheostomy: A clinical comparison of dilatational (Ciaglia)and translaryngeal (Fantoni) techniques, ANESTH ANAL, 89(4), 1999, pp. 938-943
Citations number
25
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
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.