Percutaneous dilational tracheostomy in critically ill patients: progressive vs single dilatation techniques

Objectives

To report experience with the bedside percutaneous dilatational tracheostomy (PDT) in critically ill patients. To compare two different methods of PDT, namely progressive and single dilatation techniques.

Design

Prospective observational study.

Patients

Eighteen surgical or medical ICU patients (10 male, mean age 32.8 ± 17 years) in a tertiary university hospital requiring tracheostomy for airway control or prolonged mechanical ventilation.

Interventions

Patients were randomized to receive PDT by either the multiple progressive dilatation method (group A, eight patients) or single dilatation technique (group B, 10 patients) as described by Ciaglia.

Results

Bedside PDT was performed successfully in ICU for all 18 patients in a mean time of 17.5 ± 14 min (range 5–60 min). Single dilatation technique had a significantly lower operative time than the multiple dilation group (9.5 ± 6 min vs 27.5 ± 15 min, P < 0.005). Complications were significantly higher in group A (false passage in one, moderate bleeding in one, minor bleeding in two, conversion of the procedure to open tracheostomy in one patient due to isthmus bleeding). On the other hand there was only minor bleeding in one patient of group B.

Conclusion

PDT is a safe and cost-effective procedure in ICU critically ill patients. The single dilatation method is an even more rapidly performed bedside method than the progressive dilation method.