Percutaneous tracheostomy: Ciaglia Blue Rhino versus the basic ciaglia technique of percutaneous dilational tracheostomy

Percutaneous dilational tracheostomy (PDT), according to Ciaglia's techniqu e described in 1985, has become the most popular technique for percutaneous tracheostomy and is demonstrably as safe as surgical tracheostomy. In 1999 , an extensively modified technique of PDT was introduced, the Ciaglia Blue Rhino (CBR; Cook Critical Care, Bloomington, IL, that consists of one-step dilation by means of a curved dilator with hydrophilic coating. To compare CBR with the basic technique of PDT, we performed a prospective, randomize d trial in 50 critically ill adults. Twenty-five of these patients had PDT, and 25 had CBR Average operating times were <3 min for CBR (range: 50-360 s) and <7 min for PDT (range: 4-20 min; P < 0.0001). Tracheostomy was succe ssfully completed in all patients. When CBR was performed, 11 minor, nonlif e-threatening complications were noted: nine fractures of tracheal cartilag e and two short periods of intraoperative oxygen desaturation. During PDT, seven complications occurred, of which three were potentially life-threaten ing: two injuries to the posterior tracheal wall, one pneumothorax, two tra cheal cartilage fractures (P < 0.05 vs CBR), one case of bleeding, and one short episode of intraoperative oxygen desaturation. Regardless of whether PDT or CBR was performed, oxygenation was not significantly affected, and t here was no infection of the tracheostoma. Based on our data, we conclude t hat new CBR is more practicable than PDT. No life-threatening complications occurred during CBR.