Percutaneous dilatational tracheostomy

Tracheostomies are elective procedures performed in already intubated patie nts in whom prolonged mechanical ventilation is expected. Surgical open tra cheostomy - which is usually performed by a surgeon in the operating theatr e - has been the procedure of choice for decades. More recently, percutaneo us dilatational tracheostomy (PT) techniques - which are bedside procedures which can be performed by any trained specialist - are becoming increasing ly popular. PT consists of percutaneous needle puncture of the trachea, fol lowed by stepwise (Ciaglia technique, using dilators of increasing size) or one-time (Griggs technique, using dedicated dilator forceps) dilatation an d placement of a tracheostomy tube. The indications of PT being similar to those of surgical open tracheostomy, the former seems to offer various adva ntages over ST, including logistic benefits (no need for an operating theat re and time, no need for patient transport, hence less time between the dec ision and performance of tracheostomy, and cost savings), and an equal or e ven better safety profile (less immediate and long-term complications). Nec essary requirements for PT are a trained operator (which may be a surgeon o r an ICU specialist) and assistants (probably including an experienced endo scopist for peroperative endoscopic control). PT is a safe bedside ICU proc edure in experienced hands, and may - due to its relative simplicity, safet y and bedside performance - influence optimal airway management strategies in the future.