Clinical review: percutaneous dilatational tracheostomy

Abstract

As the number of critically ill patients requiring tracheotomy for prolonged ventilation has increased, the demand for a procedural alternative to the surgical tracheostomy (ST) has also emerged. Since its introduction, percutaneous dilatational tracheostomies (PDT) have gained increasing popularity. The most commonly cited advantages are the ease of the familiar technique and the ability to perform the procedure at the bedside. It is now considered a viable alternative to (ST) in the intensive care unit. Evaluation of PDT procedural modifications will require evaluation in randomized clinical trials. Regardless of the PDT technique, meticulous preoperative and postoperative management are necessary to maintain the excellent safety record of PDT.

Figure 1

A comparison of perioperative complications with five different PDT techniques. *P < 0.05 versus any other technique; ^†P < 0.05 versus PDT, TLT and BR. BR, Blue Rhino; CPDT, Ciaglia's percutanous dilatational tracheostomy; GWDF, guidewire dilating forceps; TLT, translaryngeal tracheostomy; PDT, percutanous dilatational tracheostomy; PT, PercuTwist technique.

Figure 2

Death and pneumonia. Shown is a summary of death and pneumonia as outcome measures in the early tracheostomy group versus the prolonged translaryngeal intubation group. Data from Rumbak and coworkers [64]. *P < 0.005.

Figure 3

Other outcome measures. Shown is a summary of other outcome measures in the early tracheostomy group versus the prolonged translaryngeal intubation group. Data from Rumbak and coworkers [64]. *P < 0.001.