Percutaneous tracheostomy: comparison of Ciaglia and Griggs techniques

Endoscopic percutaneous dilatational tracheostomy is at least as safe as st andard open tracheostomy in the operating room (OR). Recently, a single dil ator was introduced to accomplish dilatation of the tracheal aperture in on e step, thus obviating the need for multiple graduated dilators. Experience with endoscopic percutaneous tracheostomy (PCT) using the single dilator i n 40 patients to date supports the premise that the procedure is safe, rapi d, and technically simple. In the study by Anon ef al, two very different t echniques, are compared: the Ciaglia percutaneous dilatational tracheostomy technique using multiple dilators and the Griggs percutaneous technique us ing guidewire-dilating forceps. Although relative complication rates for th e two techniques are not significantly different, both procedures are perfo rmed in a 'blind' fashion, without the benefit of a bronchoscope. The repor ted incidence of serious complications in this study is high, and almost ce rtainly avoidable with the addition of direct bronchoscopic visualization. Operative time is reported to be shorter with the Griggs technique, but thi s finding is unlikely to hold true for the single dilator technique, which reduces procedure time to less than 15 min. This author's experience with b edside endoscopic PCT using the single dilator indicates that it is a safe, rapid and cost-effective procedure with a low complication rate.