Percutaneous tracheostomy: comparison of Ciaglia and Griggs techniques

Abstract

Although the standard tracheostomy described in 1909 by Jackson has been extensively used in critical patients, a more simple procedure that can be performed at the bedside is needed. Since 1957 several different types of percutaneous tracheostomy technique have been described. The purpose of the present study was to compare two bedside percutaneous tracheostomy techniques: percutaneous dilatational tracheostomy (PDT) and the guidewire dilating forceps (GWDF). A prospective study in two medical/surgical intensive care units (ICUs) was carried out. Sixty-three critically ill patients who required endotracheal intubation for longer than 15 days were consecutively selected to undergo PDT (25 patients) or GWDF (38 patients) technique. Intraoperative and postoperative complications were recorded. ) with concomitant subcutaneous emphysema ensued. We found no statistical differences between complications with both techniques. The surgical time required for the GWDF technique was less than that for PDT.

Background:

Although the standard tracheostomy described in 1909 by Jackson has been extensively used in critical patients, a more simple procedure that can be performed at the bedside is needed. Since 1957 several different types of percutaneous tracheostomy technique have been described. The purpose of the present study was to compare two bedside percutaneous tracheostomy techniques: percutaneous dilatational tracheostomy (PDT) and the guidewire dilating forceps (GWDF).

Materials and methods:

A prospective study in two medical/surgical intensive care units (ICUs) was carried out. Sixty-three critically ill patients who required endotracheal intubation for longer than 15 days were consecutively selected to undergo PDT (25 patients) or GWDF (38 patients) technique. Intraoperative and postoperative complications were recorded.

Results:

) with concomitant subcutaneous emphysema ensued.

Conclusion:

We found no statistical differences between complications with both techniques. The surgical time required for the GWDF technique was less than that for PDT.

Introduction

]. The most severely ill patients admitted to an ICU often require a tracheostomy. A simple procedure, with a lower rate of complications and that can be performed at the bedside to eliminate the risk of transport to the operating room, is needed.

] reported on the GWDF technique in 1990. This method is uses a forceps similar to the that of the Rapitrac, except for the absence of a cutting edge on the tip of the instrument.

The objective of the present study was to compare two bedside tracheostomy systems, PDT and GWDF, in a population of critical care patients in two medical/surgical ICUs.

Preparation of the patient

], PDT and GWDF were performed in the space between the cricoid and the first tracheal cartilage or between the first and second tracheal cartilages when it was possible.

Ciaglia technique was performed using the Ciaglia multiple dilator kit (Ciaglia Percutaneous Tracheostomy Introducer Set; William Cook Europe, Bjaeverskov, Denmark). Griggs technique was performed using the Percutaneous Tracheostomy Kit (Portex Ltd, Hythe, Kent, UK).

Statistical analysis

test. Data were analyzed using the Statistical Package for the Social Sciences Software (version 7.5) for Windows (SPSS Inc, Chicago, IL, USA).

Results

).

. Three patients in the GWDF group developed bleeding, as compared with only one patient in the PDT group (not significant). Tracheal tear occurred in one patient from each group. There were a total of 15 (23%) complications in 10 (15%) patients, but there was no statistical difference between procedures.

Demographic data between groups

= 0.02, versus GWDF group.

Procedure-related complications between PDT and GWDF techniques

Discussion

].

], leaving 904 PDTs performed by other investigators. Six deaths were reported for PDT. The perioperative complications of 'blind' (nonendoscopic) PDT were 8.2%.

], of 54 patients that compared both techniques has been performed. They used a bronchoscope for the first 15 cases and found that bleeding and damage to the endotracheal tube were the most common complications. They found no differences between the two groups in terms of complications.

were produced.

Hypotension was transient, and it was related only to the administration of the anaesthesic agents. Haemorrhage did not require surgical ligation, surgical exploration or delay of the procedure. Only one patient needed blood transfusion due to haemorrhage after the procedure. The bleeding was stopped with conservative measures.

In three patients we were unable to complete the procedure. The first case, with the PDT technique, this was due to abnormal vasculature in the neck and we completed the procedure using a standard tracheostomy. The other two cases (with GWDF) were completed with PDT techique because of inability to pass the tracheostomy tube through the stoma. This was probably due to the design of the obturator in the first version of the kit launched in Spain. Once this obturator was replaced by an improved one, the problem did not occur.

], although the mean time required to perform the GWDF technique was significantly less than that required to perform the PDT technique. The overall time ranged from 6 min when the technique was performed by intensivists who were experienced with both techniques, to 45 min when the physician who performed the procedure had no previous experience. Also the tracheal tear associated with false passage in a patient described above could have been be due to this lack of experience.

].

].

We conclude that both techniques result in a safe placement of a tracheostomy tube in the ICU. Although bleeding was more common with GWDF, this was not statistically significant and the higher mortality in this group of patients was not related to the technique. The mean duration of procedure was significantly lower with GWDF than with PDT technique.

Keywords

• complications
• percutaneous
• tracheostomy