Percutaneous dilatational tracheostomy

Abstract

For decades, the standard technique for tracheostomy was the open, surgical technique. However, during the past 20 years, the use of percutaneous dilatational tracheostomy has been increased and shown to be a feasible and safe procedure in critically ill patients. The purpose of this report is to review the percutaneous dilatational tracheostomy technique, describe the role of bronchoscopy as guidance for the procedure, and identify the available evidences comparing percutaneous dilatational tracheostomy to surgical tracheostomy.

Keywords: Bronchoscopy; Critically Illness; Surgical Procedures, Minimally Invasive; Tracheostomy.

Figure 1

Methods of percutaneous tracheostomy used before Ciaglia's technique. (A) Shelden 1955, (B) Toy and Weinstein 1969, (C) Schachner 1986; quoted in Kost KM. Reprinted from Kost KM. Laryngoscope 2005;115:1-30.

Figure 2

Ciaglia's technique. Reprinted from Ciaglia P, et al. Chest 1985;87:715-9; Marx WH, et al. Chest 1996;110: 762-6.

Figure 3

Post-Ciaglia's technique attempted for percutaneous tracheostomy. (A) Griggs 1990, (B) Fantoni 1993, (C) "PercuTwist" 2002; quoted in Kost KM. Reprinted from Kost KM. Laryngoscope 2005;115:1-30.

Figure 4

Odds ratio of percutaneous dilatational tracheostomy related complications in comparison to surgical tracheostomy. Reprinted from Freeman BD, et al. Chest 2000;118:1412-8.

Figure 5

Look of patient with neck extension. Adapted from Kim KH. Tracheostomy. Seoul: Korean Institute of Medicine; 2007.

Figure 6

Anatomy of anterior neck area (A), actual look of marking on the surgical area (B). Adapted from De Leyn P, et al. Eur J Cardiothorac Surg 2007; 32:412-21.

Figure 7

Percutaneous dilatational tracheostomy set (A), T-cannula with pre-mounted loader (B). Adapted from Susarla SM, et al. J Oral Maxillofac Surg 2012;70:74-82.

Figure 8

Post-vertical incision look compared to the retractor (A). Mimetic diagrams of the transverse incision and the longitudinal incision (B). Adapted from Kim KH. Tracheostomy. Seoul: Korean Institute of Medicine; 2007.

Figure 9

Personnel disposition for the procedure (A); bronchoscope positioned ensuring the tip of E-tube is visible (B); puncture, guide-wire insertion and dilator insertion (C~E).

Figure 10

Insertion of a short guide dilator (A). Insertion of a support (B).

Figure 11

Checking T-tube insertion from above before E-tube removal immediately after the procedures (A). Checking below carina through T-tube immediately after the procedures (B).