[Dilatation tracheotomy update : indications, limitations and management of complications]

Percutaneous dilatational tracheotomy is a standard procedure today for transient airway management in intensive care units. When correctly indicated and applied, preferably following interdisciplinary case discussion with the otolaryngologist, PDT seems to be as safe as classical surgical tracheotomy. The latter is the alternative when PDT is contraindicated. There is currently a trend towards one-step PDT procedures. In addition to the permanent necessity for an alternative airway, there is a series of clearly defined contraindications to PDT. In such cases, only surgical tracheotomy is viable. In contrast to surgical tracheotomy, PDT presents more challenges to the physicians and nursing staff in order to avoid specific complications such as re-cannulation into a via falsa followed by acute dyspnea. The otolaryngologist is an important partner in the management of PDT-related complications due to his discipline-specific experience. Further prospective trials, especially concerning long-term complications, are needed to answer the question of whether PDT or surgical tracheotomy is the best method in situations with overlapping indications.