Evolution of percutaneous dilatational tracheostomy--a review of current techniques and their pitfalls

Tracheostomy is the most commonly performed surgical procedure in critically ill patients with acute respiratory failure. While few absolute indications exist, this procedure is widely used in patients with upper respiratory obstruction and those requiring long-term mechanical ventilation. The traditional approach to tracheostomy has been an open procedure performed in the operating room. This method is associated with an increased rate of complications and costs. Accordingly, percutaneous bedside tracheostomy procedures have largely replaced the traditional operative approach at many institutions. Numerous methods for percutaneous tracheostomy have thus emerged. However, the benefits of one technique versus another have not been well demonstrated. In this article, we review the evidence supporting the use of percutaneous tracheostomy procedures over the traditional operative approach. Furthermore, we review the currently available and emerging methods by which percutaneous tracheostomy can be performed. In addition, we highlight the available evidence concerning the safety and complication rates of each technique.