Percutaneous tracheostomy

The purpose of this review is to discuss the various techniques of percutaneous tracheostomy and to assess their safety and efficacy profile, indications and contraindications, early and late complications. Literature was reviewed from Medline and MD Consult databases. Early techniques by Sheldon, toye and Schachner have been abandoned due to their high complication rates. Percutaneous dilational tracheostomy using the Ciaglia kit (Wiliam Cook Europe Bjaeverskov) and a Griggs kit (Portex PDT kit, POrtex, Hythe, Kent, UK) has been used most often. Griggs guide Wire Dilator Forceps kit (SIMS, Portex, Hythe, Kent, UK) is the next most common in use but its long-term studies are few. Fantoni (TLT set, Mallinckrodt Medical) and PercuTwist device (Riisch, Kernen, Germany) are two new techniques currently under study. Percutaneous dilational tracheostomy and conventional surgical tracheostomy are still competing methods to provide an airway for intensive care patient requiring assisted ventilation. Review of literature shows that percutaneous tracheostomy is safe, cost-effective and compares favourably with the open surgical tracheostomy. Many intensive care units now use the percutaneous tracheostomy as a procedure of choice. Percutaneous tracheostomy has a learning curve and requires appropriate case selection and meticulous attention to the technique by all those who want to use this method.