Percutaneous dilation tracheostomy during high-frequency oscillatory ventilation

Retrograde Percutaneous Tracheostomy. Early Experience With a Cadaveric Case Report

Despite the many accomplishments since the introduction of percutaneous dilational (PDT) tracheostomy, we continue to observe emerging complications as we forge ahead in intensive care practice. As a result of this, we provide a new technique that could avoid some complications, notably posterior tracheal wall injury, bronchoscopic or endotracheal tube puncture, and false track. The new technology was evaluated on a 75-year-old Caucasian male cadaver was selected for a novel PDT technique. A wire with a sharp terminal end passed through the bronchoscopic channel and punctured the trachea from inside towards the skin. The wire was pulled and directed towards the mediastinum. The rest of the technique was carried out like a routine procedure. The procedure was technically feasible; further clinical trials are required to confirm the validity of this technique.

Percutaneous tracheostomy: a comprehensive review

Tracheostomy is a common procedure. It can be done surgically or percutaneously by dilating the stoma using Seldinger technique. Percutaneous tracheostomy (PT) is now routinely performed by surgeons and non-surgeons such as intensivists and anesthesiologists in the intensive care units (ICU) all over the world. Although obesity, emergent tracheostomy, coagulopathy, inability to extend the neck and high ventilator demand (HVD) were initially thought to be a relative contraindication, recent data suggest safety of PT in these patient population. Ultrasound can be helpful in limited cases to identify the neck structure especially in patients with a difficult anatomy. Bronchoscopy during PT can shorten the duration and avoid complications. PT has favorable complication rate, lower infection rate, shorter procedural duration and is cost-effective. Experience with the technique and careful planning is needed to minimize any avoidable potential complication.

Percutaneous dilational tracheostomy

Tracheostomy is a commonly performed intervention with several benefits in the treatment of patients with chronic respiratory failure. Percutaneous dilational tracheostomy techniques have allowed bedside tracheostomy placement in the modern intensive care unit. Percutaneous dilational tracheostomy can be safely performed by interventional pulmonologists, medical intensive care physicians, and surgical specialists. When performed with the assistance of adjuncts, such as flexible bronchoscopy, the percutaneous dilational method has a favorable complication rate, efficiency, and cost profile compared with surgical tracheostomy.

Percutaneous tracheotomy

Tracheotomy is one of the most commonly performed procedures in critically ill patients. This article describes in particular the use of percutaneous dilatational tracheotomy. A brief history is included.

Pitfalls in percutaneous dilational tracheostomy using the Ciaglia one-step technique

Surgical tracheostomy was first described in 1909. Since then, it has become a standard procedure for patients requiring prolonged mechanical ventilation. More recently, bedside percutaneous tracheostomy has been shown to be as safe and effective as the surgical technique, but with the added advantage of also being technically straightforward and cost-efficient. Partly because of this, percutaneous tracheostomy is now being performed by nonsurgeon intensivists. However, the relative ease of the procedure may mask many potential pitfalls that can result in morbidity. As such, it is important for all intensivists to be familiar with the steps and potential pitfalls of this procedure. This is an evidence-based review of the common pitfalls associated with the Ciaglia one-step percutaneous tracheostomy technique, the method most commonly utilized for percutaneous tracheostomy insertion in the United States.

Clinical review: percutaneous dilatational tracheostomy

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.