[Percutaneous tracheotomy: personal contributions to the technique]

We developed within our service of intensive care a hybrid procedure combining the advantages of the techniques of Caglia and Fantoni. Ventilation downstream from the site of dilatation, thanks to a longer tracheal tube of small diameter, ensures an optimal spirometry and reduces to a minimum the time of apnea. It decreases the risks of per-operational subcutaneous emphysema. A system of camera video assembled on a flexible fibroscope allows a direct vision on television screen. The operator can, constantly, visualise his gesture in one glance, in real time. Such an approach increases the security and the effectiveness of the method. The procedure remains nevertheless simple and does not require a thorough experience in percutaneous dilatational tracheotomy.