Percutaneous tracheostomy: a review.

Objectives: The aim of this study was to evaluate the different techniques of percutaneous tracheostomies, their advantages, drawbacks, complications and to compare them to standard surgical tracheostomies. This study will co nsider only elective (non emergency) bedside procedures in intensive care u nits. Data sources: Extraction from Medline((R)) database of english and french a rticles on percutaneous tracheostomies and searching along with major revie w articles. Study selection: The collected articles were selected according to their qu alities regarding to their evidence level. In addition to several important or historic references, the literature of the five past years was studied. Data extraction: The articles were reviewed according to their contribution for techniques, perioperative and postoperative complications, recent adva nces, advantages and drawbacks of all procedures. Publications addressing r ecent comparisons between surgical and percutaneous tracheostomies were spe cially studied. Data synthesis: Four techniques of bedside percutaneous tracheostomies are available and marketed, in France: Ciaglia's dilation technique (with multi ple or unique dilator), Griggs's technique (using a special designed forcep s), and Fantoni's technique (Trans Laryngeal Tracheostomy). The most spred but also first described technique is the Ciaglia's (1985). The most recent articles comparing surgical and percutaneous tracheostomies techniques are not able to demonstrate a superiority of one of them in terms of feasibili ty or safety. In other words, there should be a slight advantage for the pe rcutaneous tracheostomy regarding to the late post-operative complications, as there should be a slight advantage for the surgical techniques regardin g to the perioperative complications. The literature analysis point out fir stly the learning curve for percutaneous dilational tracheostomy, with a si gnificant decrease of complication incidence with the operator's experience and secondly the continuous endoscopic guidance seems to increase the safe ty of the percutaneous procedure. Conclusion: Since there has been a great deal of percutaneous tracheostomy in the intensive care units, the incidence of tracheostomy have increased i n those services. There is a trend to replace the surgical procedure by the percutaneous one. However, according to the potentially jeopardizing compl ications, percutaneous tracheostomy should be done by an experienced operat or with the help of a continuous endoscopic guidance. (C) 2001 Editions sci entifiques et medicales Elsevier SAS.