Prospective randomized comparison of progressive dilational vs forceps dilational percutaneous tracheostomy

Area of Science:

• Critical Care Medicine
• Surgical Procedures

Background:

• Percutaneous tracheostomy is a common ICU procedure.
• Two primary methods include Ciaglia progressive dilational and Griggs forceps techniques.

Purpose of the Study:

• To prospectively compare the Ciaglia progressive dilational tracheostomy and Griggs forceps dilational tracheostomy.
• Evaluate operative time, physiological changes, and complication rates.

Main Methods:

• A randomized, single-blinded trial involving 100 ICU patients.
• Comparison of progressive vs. forceps percutaneous tracheostomy at the bedside.
• Data collection on operative duration, hypoxemia, hypercapnia, and complications.

Main Results:

• Progressive technique: longer operative time (median 7 vs. 4 minutes, P=0.0005).
• Progressive technique: increased hypercapnia (56 vs. 49 mmHg, P=0.0082).
• Progressive technique: higher rates of minor (31 vs. 9) and major complications (6 vs. 0), P<0.0001.

Conclusions:

• The progressive dilational tracheostomy is associated with longer operative times.
• The progressive technique resulted in more hypercapnia and a higher incidence of both minor and major complications.
• The Griggs forceps technique demonstrated a superior safety and efficiency profile in this comparative trial.