Tuberc Respir Dis.  2012 Mar;72(3):261-274.

Percutaneous Dilatational Tracheostomy

Affiliations
  • 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. lungdrcho@snubh.org

Abstract

For decades, the standard technique for tracheostomy was the open, surgical technique. However, during the past 20 years, the use of percutaneous dilatational tracheostomy has been increased and shown to be a feasible and safe procedure in critically ill patients. The purpose of this report is to review the percutaneous dilatational tracheostomy technique, describe the role of bronchoscopy as guidance for the procedure, and identify the available evidences comparing percutaneous dilatational tracheostomy to surgical tracheostomy.

Keyword

Tracheostomy; Surgical Procedures, Minimally Invasive; Critically Illness; Bronchoscopy

MeSH Terms

Bronchoscopy
Critical Illness
Humans
Surgical Procedures, Minimally Invasive
Tracheostomy

Figure

  • Figure 1 Methods of percutaneous tracheostomy used before Ciaglia's technique. (A) Shelden 1955, (B) Toy and Weinstein 1969, (C) Schachner 1986; quoted in Kost KM3. Reprinted from Kost KM. Laryngoscope 2005;115:1-303.

  • Figure 2 Ciaglia's technique. Reprinted from Ciaglia P, et al. Chest 1985;87:715-95; Marx WH, et al. Chest 1996;110: 762-69.

  • Figure 3 Post-Ciaglia's technique attempted for percutaneous tracheostomy. (A) Griggs 1990, (B) Fantoni 1993, (C) "PercuTwist" 2002; quoted in Kost KM3. Reprinted from Kost KM. Laryngoscope 2005;115:1-303.

  • Figure 4 Odds ratio of percutaneous dilatational tracheostomy related complications in comparison to surgical tracheostomy. Reprinted from Freeman BD, et al. Chest 2000;118:1412-819.

  • Figure 5 Look of patient with neck extension. Adapted from Kim KH. Tracheostomy. Seoul: Korean Institute of Medicine; 200725.

  • Figure 6 Anatomy of anterior neck area (A), actual look of marking on the surgical area (B). Adapted from De Leyn P, et al. Eur J Cardiothorac Surg 2007; 32:412-2126.

  • Figure 7 Percutaneous dilatational tracheostomy set (A), T-cannula with pre-mounted loader (B). Adapted from Susarla SM, et al. J Oral Maxillofac Surg 2012;70:74-8212.

  • Figure 8 Post-vertical incision look compared to the retractor (A). Mimetic diagrams of the transverse incision and the longitudinal incision (B). Adapted from Kim KH. Tracheostomy. Seoul: Korean Institute of Medicine; 200725.

  • Figure 9 Personnel disposition for the procedure (A); bronchoscope positioned ensuring the tip of E-tube is visible (B); puncture, guide-wire insertion and dilator insertion (C~E).

  • Figure 10 Insertion of a short guide dilator (A). Insertion of a support (B).

  • Figure 11 Checking T-tube insertion from above before E-tube removal immediately after the procedures (A). Checking below carina through T-tube immediately after the procedures (B).


Reference

1. Jackson C, Jackson CL. The larynx and its diseases. 1937. Philadelphia: W. B. Saunders.
2. Zeitouni AG, Kost KM. Tracheostomy: a retrospective review of 281 cases. J Otolaryngol. 1994. 23:61–66.
3. Kost KM. Endoscopic percutaneous dilatational tracheotomy: a prospective evaluation of 500 consecutive cases. Laryngoscope. 2005. 115(10 Pt 2):1–30.
4. Zagli G, Linden M, Spina R, Bonizzoli M, Cianchi G, Anichini V, et al. Early tracheostomy in intensive care unit: a retrospective study of 506 cases of video-guided Ciaglia Blue Rhino tracheostomies. J Trauma. 2010. 68:367–372.
5. Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report. Chest. 1985. 87:715–719.
6. Shelden CH, Pudenz RH, Freshwater DB, Crue BL. A new method for tracheotomy. J Neurosurg. 1955. 12:428–431.
7. Toy FJ, Weinstein JD. A percutaneous tracheostomy device. Surgery. 1969. 65:384–389.
8. Schachner A, Ovil Y, Sidi J, Rogev M, Heilbronn Y, Levy MJ. Percutaneous tracheostomy: a new method. Crit Care Med. 1989. 17:1052–1056.
9. Marx WH, Ciaglia P, Graniero KD. Some important details in the technique of percutaneous dilatational tracheostomy via the modified Seldinger technique. Chest. 1996. 110:762–766.
10. Byhahn C, Wilke HJ, Halbig S, Lischke V, Westphal K. Percutaneous tracheostomy: ciaglia blue rhino versus the basic ciaglia technique of percutaneous dilational tracheostomy. Anesth Analg. 2000. 91:882–886.
11. Dempsey GA, Grant CA, Jones TM. Percutaneous tracheostomy: a 6 yr prospective evaluation of the single tapered dilator technique. Br J Anaesth. 2010. 105:782–788.
12. Susarla SM, Peacock ZS, Alam HB. Percutaneous dilatational tracheostomy: review of technique and evidence for its use. J Oral Maxillofac Surg. 2012. 70:74–82.
13. Griggs WM, Worthley LI, Gilligan JE, Thomas PD, Myburg JA. A simple percutaneous tracheostomy technique. Surg Gynecol Obstet. 1990. 170:543–545.
14. Ambesh SP, Pandey CK, Srivastava S, Agarwal A, Singh DK. Percutaneous tracheostomy with single dilatation technique: a prospective, randomized comparison of Ciaglia blue rhino versus Griggs' guidewire dilating forceps. Anesth Analg. 2002. 95:1739–1745.
15. Fikkers BG, Staatsen M, van den Hoogen FJ, van der Hoeven JG. Early and late outcome after single step dilatational tracheostomy versus the guide wire dilating forceps technique: a prospective randomized clinical trial. Intensive Care Med. 2011. 37:1103–1109.
16. Westphal K, Byhahn C, Wilke HJ, Lischke V. Percutaneous tracheostomy: a clinical comparison of dilatational (Ciaglia) and translaryngeal (Fantoni) techniques. Anesth Analg. 1999. 89:938–943.
17. Frova G, Quintel M. A new simple method for percutaneous tracheostomy: controlled rotating dilation. A preliminary report. Intensive Care Med. 2002. 28:299–303.
18. Dulguerov P, Gysin C, Perneger TV, Chevrolet JC. Percutaneous or surgical tracheostomy: a meta-analysis. Crit Care Med. 1999. 27:1617–1625.
19. Freeman BD, Isabella K, Lin N, Buchman TG. A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest. 2000. 118:1412–1418.
20. Freeman BD, Isabella K, Cobb JP, Boyle WA 3rd, Schmieg RE Jr, Kolleff MH, et al. A prospective, randomized study comparing percutaneous with surgical tracheostomy in critically ill patients. Crit Care Med. 2001. 29:926–930.
21. Delaney A, Bagshaw SM, Nalos M. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis. Crit Care. 2006. 10:R55.
22. Silvester W, Goldsmith D, Uchino S, Bellomo R, Knight S, Seevanayagam S, et al. Percutaneous versus surgical tracheostomy: A randomized controlled study with long-term follow-up. Crit Care Med. 2006. 34:2145–2152.
23. Fanara B, Manzon C, Barbot O, Desmettre T, Capellier G. Recommendations for the intra-hospital transport of critically ill patients. Crit Care. 2010. 14:R87.
24. Seder DB, Lee K, Rahman C, Rossan-Raghunath N, Fernandez L, Rincon F, et al. Safety and feasibility of percutaneous tracheostomy performed by neurointensivists. Neurocrit Care. 2009. 10:264–268.
25. Kim KH. Tracheostomy. 2007. 1st ed. Seoul: Korean Institute of Medicine.
26. De Leyn P, Bedert L, Delcroix M, Depuydt P, Lauwers G, Sokolov Y, et al. Tracheotomy: clinical review and guidelines. Eur J Cardiothorac Surg. 2007. 32:412–421.
27. Paul A, Marelli D, Chiu RC, Vestweber KH, Mulder DS. Percutaneous endoscopic tracheostomy. Ann Thorac Surg. 1989. 47:314–315.
28. Al-Ansari MA, Hijazi MH. Clinical review: percutaneous dilatational tracheostomy. Crit Care. 2006. 10:202.
29. Tabaee A, Geng E, Lin J, Kakoullis S, McDonald B, Rodriguez H, et al. Impact of neck length on the safety of percutaneous and surgical tracheotomy: a prospective, randomized study. Laryngoscope. 2005. 115:1685–1690.
30. Romero CM, Cornejo RA, Ruiz MH, Gálvez LR, Llanos OP, Tobar EA, et al. Fiberoptic bronchoscopy-assisted percutaneous tracheostomy is safe in obese critically ill patients: a prospective and comparative study. J Crit Care. 2009. 24:494–500.
31. Cabrini L, Bergonzi PC, Mamo D, Dedola E, Colombo S, Morero S, et al. Dilatative percutaneous tracheostomy during double antiplatelet therapy: two consecutive cases. Minerva Anestesiol. 2008. 74:565–567.
32. Auzinger G, O'Callaghan GP, Bernal W, Sizer E, Wendon JA. Percutaneous tracheostomy in patients with severe liver disease and a high incidence of refractory coagulopathy: a prospective trial. Crit Care. 2007. 11:R110.
33. Romero-Ganuza J, Gambarrutta C, Merlo-Gonzalez VE, Marin-Ruiz MÁ, Diez De La Lastra-Buigues E, Oliviero A. Complications of tracheostomy after anterior cervical spine fixation surgery. Am J Otolaryngol. 2011. 32:408–411.
34. Rodríguez SJ, Esteves LE. Real-time ultrasound-guided percutaneous dilatational tracheostomy. Crit Care. 2011. 15:443.
35. Flint AC, Midde R, Rao VA, Lasman TE, Ho PT. Bedside ultrasound screening for pretracheal vascular structures may minimize the risks of percutaneous dilatational tracheostomy. Neurocrit Care. 2009. 11:372–376.
36. Rajajee V, Fletcher JJ, Rochlen LR, Jacobs TL. Real-time ultrasound-guided percutaneous dilatational tracheostomy: a feasibility study. Crit Care. 2011. 15:R67.
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