Naushad's Modification of Griggs Percutaneous Tracheostomy: Retrospective Case Series Study on 200 Patients at Subharti Medical College, Meerut, India

Abstract

Introduction:Percutaneous dilational tracheostomy (PDT) is a frequently performed procedure in critically ill patients in hospital emergency department, intensive care unit (ICU) and operating theater (OT). The purpose of this study is to describe a technical modification of Griggs percutaneous tracheostomy by using two 7G and 12G dilators after undergoing sterilization by ethylene oxide. Two hundred patients underwent the procedure. There were no major complications related to the procedure. There were two minor bleedings managed conservatively. The technical modification described in this study is safe and simple to execute and is most cost effective. Materials and methods: Patients admitted to ICUs on prolonged mechanical ventilation who are difficult to wean and ventilate, those with facial trauma, oropharyngeal cancer patients, burn patients, a child with diphtheria, patients with chronic obstructive pulmonary disease requiring tracheostomy were included in our retrospective study. The study group underwent PDT using the Naushad's modified Griggs technique. The time taken to perform the procedure, its ease of insertion, number of attempts and its early and late procedural complications were recorded. Results:The time taken by tracheostomy was 3-10 minutes. Our method is most cost effective, as it costs only around 1000 INR/15$, while the whole set of Griggs technique costs around 15000 INR/150 US $. There was only one post procedural infection, no long-term morbidity and a single case got converted to surgical tracheostomy. Conclusion:The technique seems reliable for carrying out percutaneous PDT at bedside in all patients admitted to different hospital departments, including ICUs, triage, emergency and routine OT, as a measure to secure the airway by mainly involving the oral and neck area.

FIGURE 1.

Griggs forceps, two dilators, 16 G needles, two artery forceps, blade, guide wire, 5 mL syringe and Ramsons per cutaneous tracheostomy tube

FIGURE 2.

PCT in severe burn patient, with one intensivist standing on the right side of the patient and another on the head end side

FIGURE 3.

Operated for carcinoma buccal mucosa

FIGURE 4.

Naushad’s technique

FIGURE 5.

Patient with carcinoma tongue with distorted anatomy

FIGURE 6.

Patient after PCT by Naushad’s technique

FIGURE 7.

Patient with intracranial bleed requiring long term ventilation. PCT done by Naushad’s technique

FIGURE 8.

Child with severe head injury

FIGURE 9.

Number of patients admitted in different sections of hospital

FIGURE 10.

Complications related to pct by Naushad’s technique

FIGURE 11.

Category of patients subjected to PCT

TABLE 1.

Different characteristics and parameters used while performing PCT by Naushad’s technique