Percutaneous tracheostomy

Background: Percutaneous tracheostomy (PT) has gained an increasing accepta nce as an alternative to the conventional surgical tracheostomy (ST). In ex perienced hands, and with proper patient selection, it is safe, easy and qu ick. Complications: Perioperative complications are comparable with those of ST and these are mostly minor. An important advantage of PT over ST is that th ere is no need to move a critically ill patient to the operating room and t he rate of stomal infection is very low. Although data on late complication s of PT are not yet sufficient, available reports show a favourable result. Techniques: Ciaglia's method is the most commonly applied, but no study has shown superiority of any of the percutaneous techniques described. The dec ision on which method to use should solely be made depending on the clinica l situation and the experience of the operator. The learning curve demands caution, attention to detail and adequate experience on the part of the int ensive care physician. Although PT is unfortunately declared 'easy', it mus t be left in the hands of experienced physicians to avoid unnecessary compl ications, and the risk of overimplementation should be kept in mind.