Translaryngeal tracheostomy in highly unstable patients

Percutaneous tracheostomy is a widely accepted and commonly performed techn ique for attaining long-term airway access in critically ill patients. Howe ver, severe respiratory failure and coagulopathy are relative contraindicat ions for these procedures. We describe two patients with severe respiratory failure and inhibitor-complicated haemophilia A who underwent elective per cutaneous tracheostomy performed translaryngeally, using the new Fantoni te chnique. Apart from two minor bleeding episodes in the haemophilic patient which were controlled promptly, no other complications occurred. If certain precautions are observed carefully, we believe that translaryngeal tracheo stomy is a procedure which is superior to other percutaneous techniques and safe even in patients with severe respiratory failure and coagulopathy.