Percutaneous tracheostomy: comparison of Ciaglia and Griggs techniques

Background: Although the standard tracheostomy described in 1909 by Jackson has been extensively used in critical patients, a more simple procedure th at can be performed at the bedside is needed. Since 1957 several different types of percutaneous tracheostomy technique have been described. The purpo se of the present study was to compare two bedside percutaneaus tracheostom y techniques: percutaneous dilatational tracheostomy (PDT) and the guidewir e dilating forceps (GWDF). Materials and methods: A prospective study in two medical/surgical intensiv e care units (ICUs) was carried out. Sixty-three critically ill patients wh o required endotracheal intubation for longer than 15 days were consecutive ly selected to undergo PDT (25 patients) or GWDF (38 patients) technique. I ntraoperative and postoperative complications were recorded. Results: Age (mean+/-standard error) was 63+/-1.1 years. The patients had b een mechanically ventilated for an average of 19.8+/-1.2 days. The GWDF tec hnique was significantly faster than PDT technique (P=0.02). Fifteen compli cations occurred in 10 out of 63 (15%) patients. They were as follows: trac heal tear (one patient in each group; in one case this was due to false pas sage); transient hypotension (one patient in the PDT group and two patients in the GWDF group); atelectasis (one patient in the PDT group); and haemor rhage (one patient in the PDT group and three patients in the GWDF group). In both patients with tracheal tear, reduced arterial oxygen saturation (Sa O(2)) with concomitant subcutaneous emphysema ensued. Conclusion: We found no statistical differences between complications with both techniques. The surgical time required for the GWDF technique was less than that for PDT.