[Percutaneous tracheostomy]

Area of Science:

• Critical Care Medicine
• Surgical Techniques
• Respiratory Management

Background:

• Tracheostomy is a common procedure in intensive care units.
• Percutaneous tracheostomy has gained popularity as an alternative to surgical tracheostomy.
• Evaluating different percutaneous techniques is crucial for optimizing patient care.

Purpose of the Study:

• To compare various percutaneous tracheostomy techniques with standard surgical tracheostomies.
• To analyze the advantages, drawbacks, and complications of each method.
• To assess elective bedside procedures in intensive care settings.

Main Methods:

• Systematic literature review of Medline and major review articles.
• Selection of articles based on evidence level, focusing on the last five years.
• Data extraction on techniques, perioperative/postoperative complications, and recent comparisons.

Main Results:

• Four marketed percutaneous techniques exist: Ciaglia, Griggs, and Fantoni.
• No technique demonstrates clear superiority in feasibility or safety over others.
• Percutaneous tracheostomy may have fewer late complications, while surgical tracheostomy may have fewer perioperative complications.
• Operator experience and continuous endoscopic guidance significantly improve percutaneous tracheostomy safety.

Conclusions:

• Percutaneous tracheostomy incidence is increasing in ICUs, with a trend to replace surgical procedures.
• Potentially serious complications necessitate experienced operators and endoscopic guidance for percutaneous tracheostomy.
• The choice of technique should consider operator expertise and patient factors.