Percutaneous dilatation tracheostomy (Ciaglia's method): its use in a medical intensive care

Background and objective: Since the first description of percutaneous dilat ation tracheostomy (DTT), it has become an alternative method of equal valu e to surgical tracheostomy. This study collected the experience with DTT in a medical intensive care unit (ICU), with special reference to early and l ate complications and their management, outcome, and changes in ventilation parameters and blood gases. Patients and methods: Between March 1994 and April 1998, 74 DTTs were perfo rmed on 71 patients (52 men, 19 women; mean age 61.8 [30-80]) years, The ad mission or main diagnoses were cardiovascular disease in 34 patients, pulmo nary disease in 21, the remainder having had a variety of conditions. Results: The procedure caused complications in 21 procedures (28%): 10 case s of stomal bleeding (13.5% of total number of procedures), 2 of intratrach eal bleeding (2.7%), 2 of severe tracheal injury (2.7%) and mediastinal emp hysema in 1 (1.3%). None required intervention because of these complicatio ns. 38 patients were discharged from hospital. Cause of death in the other 33 was unrelated to the DTT. One patient developed tracheomalacia as a late complication. Ventilatory parameters and blood gases 12 hours post-DTT wer e the same as before the procedure. Conclusions: Ciaglia's method of dilatation tracheostomy is a safe procedur e also in the context of a medical ICU, if the indications are correct and the procedure performed by experienced personnel. Compared with surgical tr acheostomy it significantly reduces the burden on the patient as well as re quiring fewer personnel and less equipment.