Ciaglia Blue Rhino: A modified technique of percutaneous dilatational tracheostomy. Technique and early results

Objective: Elective tracheostomy has become an established treatment modali ty in modern intensive care medicine,and the number of percutaneously perfo rmed tracheostomies is steadily increasing. The Ciaglia Blue Rhino (CBR) re presents another percutaneous technique in which the tracheostoma is formed by one-step dilation. Our study presents the technique itself and the earl y clinical experiences. Methods: in 20 adult patients on long-term ventilation, CBR was done. After puncture of the trachea in typical manner, dilation of the tracheostoma wa s achieved in one single step by means of a curved dilator with a special h ydrophilic coating. Then, the tracheostomy tube was inserted over a curved loading dilator. Practicability and safety were determined as well as gas e xchange during the procedure by means of arterial blood gas samples. Results: As a result of the dilator's hydrophilic coating, dilation of the tracheostoma was rapidly achieved within 152 +/- 22 s,virtually free from r esistance of the trachea or the cervical tissues. Complications such as ble eding, aspiration or postoperative infection of the stoma were not noted in any of our patients. Fractures of isolated tracheal cartilage rings were s een in 5 patients, however, no therapeutic intervention was necessary. In t erms of perioperative gas exchange, pre- and postoperative levels of FiO(2) , PaO2, PaCO2 and the oxygenation index (PaO2/FiO(2)) did not change signif icantly. Conclusions: Based on our early clinical experience, Ciaglia Blue Rhino rep resents a new method that may combine the typical advantages of each of the other techniques for percutaneous tracheostomy (i.e. Ciaglia, Griggs, Fant oni) in one single technique. This method is distinguished by a high level of safety and practicability. However, further comparative trials need to b e done before a definitive judgement can be made.