Bedside percutaneous tracheostomy: Clinical comparison of Griggs and Fantoni techniques

Elective tracheostomy is widely considered the preferred airway management of patients on long-term ventilation. In addition to open tracheostomy, a n umber of percutaneous procedures have been introduced during the last two d ecades, among them techniques according to Griggs (guidewire dilating force ps, or GWDF) and to Fantoni (translaryngeal tracheostomy, or TLT). The aim of the study was to evaluate these two techniques in terms of perioperative complications, risks, and benefits in critically ill patients. A series of 100 critically ill adult patients on long-term ventilation underwent elect ive percutaneous tracheostomy, either according to the Griggs (n = 50) or F antoni (n = 50) technique. Tracheostomy was performed under general anesthe sia at the patient's bedside. The mean (+/-SD) operating times were short, 9.2 +/- 3.9 minutes (TLT) and 4.8 +/- 3.7 minutes (GWDF) on average. Periop erative complications were noted in 4% of patients during either TLT or GWD F and included massive bleeding, mediastinal emphysema, posterior tracheal wall injury, and pretracheal placement of the tracheostomy tube. With regar d to oxygenation, pre- and postoperative arterial oxygen tension divided by the fraction of inspired oxygen (PaO2/FiO(2)) ratios did not vary signific antly, and no perioperative hypoxia was noted regardless of the technique u sed. We conclude that both TLT and GWDF represent attractive, safe alternat ives to conventional tracheostomy or other percutaneous procedures if caref ully performed by experienced physicians and under bronchoscopic control.