[Percutaneous tracheostomy through dilatation with the Ciaglia Blue Dolphin(®) method]

Area of Science:

• Critical Care Medicine
• Surgical Procedures
• Respiratory Therapy

Background:

• Percutaneous tracheostomy is a common procedure in intensive care units for patients requiring prolonged mechanical ventilation.
• The Ciaglia Blue Dolphin® technique is an endoscopic-guided method for percutaneous tracheostomy.

Purpose of the Study:

• To evaluate the perioperative and postoperative complications associated with the Ciaglia Blue Dolphin® percutaneous tracheostomy technique in critically ill adult patients.

Main Methods:

• A prospective, observational cohort study was conducted in two medical-surgical Intensive Care Units.
• Seventy adult patients requiring prolonged mechanical ventilation underwent percutaneous tracheostomy using the Ciaglia Blue Dolphin® technique with endoscopic guidance.
• Data collected included demographic variables, intraoperative and postoperative complications, and mortality.

Main Results:

• Twenty-five perioperative complications occurred in 70 patients, with 23 classified as mild (e.g., minor bleeding, cannula insertion difficulty).
• Two severe complications were noted: one case of severe bleeding requiring conversion to surgical tracheostomy and one instance of false passage with desaturation.
• No life-threatening complications were reported, and 11 complications occurred during the initial learning curve.
• Postoperative complications were infrequent, with mild bleeding observed in two patients.

Conclusions:

• The Ciaglia Blue Dolphin® percutaneous tracheostomy technique, when guided by endoscopy, is a safe procedure for critically ill patients.
• The incidence of complications is influenced by the learning curve associated with the technique.
• Randomized trials are recommended to compare the benefits of this technique against other percutaneous tracheostomy methods.