Use and safety of percutaneous tracheostomy in intensive careReport of a postal survey of ICU practice

Abstract

Percutaneous tracheostomy using a graded dilatation technique was described by Ciaglia in 1985 [1]. The description of other techniques using special forceps to dilate the trachea followed. The safety and low early complication rate of percutaneous tracheostomy compared with open surgical tracheostomy have been established by several prospective studies [2][3][4][5][6][7].The long-term complications, such as tracheal stenosis, remain a source of controversy. Conventional surgical tracheostomy has been associated with a long-term tracheal stenosis rate of between 16 and 64% [2, 8]. Studies using tomography [2] and fibreoptic laryngotracheoscopy [9, 10] have shown low stenosis rates with percutaneous tracheostomy.This postal survey was designed to assess the practice and attitudes to percutaneous tracheostomy in intensive care. Questions were included on the use of fibreoptic bronchoscopy and long-term follow-up. MethodsIn 1997, a postal survey was sent to the clinical directors of 231 general intensive care units in England and Wales.Specialist units, such as pure neuro-surgical or cardiac units were not surveyed. The recipients were requested to fill in a short and simple questionnaire (Appendix). The results were statistically analysed using the Chi-squared test. A p value less than 0.05 was considered statistically significant. ResultsQuestionnaires were returned by 176 out of 231 intensive care units, yielding a 76% response rate. Of the 176 directors who replied, 129 (73.3%) used percutaneous tracheostomy as the method of choice for tracheostomies on their unit (Table 1). Only 32 (18.2%) had never used it. Six (3.4%) had stopped using the technique. In all, 78.4% were using the technique of percutaneous tracheostomy on their ICU patients. FibreoscopyIn seventy-one (49.3%) units, fibreoscopy did not feature as a routine part of the technique of percutaneous tracheostomy (Table 2) and in only 45 (31.3%) was it used routinely.

Peri‐operative complications during percutaneous tracheostomy in obese patients

“…According to recent postal surveys, percutaneous tracheostomy techniques are becoming more frequently used in ICUs [16][17][18][19].…”

Weaning from ventilator after cardiac operation using the Ciaglia percutaneous tracheostomy

“…PDT, using the Ciaglia (Cook Critical Care, Bjaeverskov, Denmark) or the Griggs (Portex SIMS, Hythe, Kent, UK) Percutaneous Tracheostomy Introducer Set, overcame the technical problems of the earlier percutaneous technique and led to the general acceptance of percutaneous tracheostomy as a bedside procedure in the critically ill patients [4,5]. Out of all percutaneous tracheostomy techniques [6,8 -10], we have chosen the Ciaglia PDT because it is the most commonly performed procedure and the most evaluated in the literature [4,5].…”

“…However, the conventional open tracheostomy performed with the Jackson's technique [2] is not a complications-free surgical procedure [3]. Therefore, percutaneous tracheostomy has gained increasing acceptance in intensive care units (ICUs) as an excellent alternative to the surgical tracheostomy: in experienced hands, and with proper patient selection, it is feasible at the patient's bedside, safe, easy, quick, and costeffective [4,5].…”

“…Out of all percutaneous tracheostomies, the Ciaglia percutaneous dilatational tracheostomy (PDT) [6] is nowadays the most widely used in ICUs [4].…”

Prevalence of tracheostomy in ICU patients. A nation-wide survey in Switzerland

“…But the percutaneous technique is not yet that popular in Switzerland, as compared to a survey in England and Wales [18]. Beside political reasons (surgeons preferring open conventional tracheostomies to keep up practice in this operation) a similar lack of data, especially concerning long-term complications of the percutaneous procedure, may be responsible for the fact that more units still offer conventional open tracheostomy.…”