[Indications and technique of percutaneous dilatation tracheotomy for intensive care patients]

Since the different techniques of percutaneous dilatational tracheotomy were introduced they have attracted particular attention in the intensive care setting. We present here a modification of the technique first described by Ciaglia in 1985. Objective of this study was to evaluate the frequency of complications of this modification in comparison with published data.

151 dilatational tracheotomies were performed on 141 patients of an anaesthesiologic intensive care unit. Ciaglia originally presented an approach between the cricoid cartilage and the first tracheal cartilage. We found it preferable to insert the cannula between the 2nd and 3rd tracheal cartilage after blunt dissection of the pretracheal tissues. The Dilators of Cook Critical Care Ltd. were used in this study.

With 151 tracheotomies only 11 complications were noted: pneumothorax (1), bleeding (2), mucosal lesion of the trachea (2), others (6). None of these complications was considered to be serious. There was no tracheotomy-related death. Tracheotomy was performed within 11.5 min (range 5 to 23 min). The duration of artificial ventilation following tracheotomy was 21.1 days (range 1 to 142 days).

The presented modification of dilatational tracheotomy is a safe and effective technique which can be performed on the intensive care unit. Compared with conventional tracheotomy the new method is quickly done and will be an integral part of intensive care treatment.