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  • Letter
  • Open Access

Percutaneous tracheostomy: it’s time for a shared approach!

Critical Care201418:448

  • Published:


  • Clinical Practice
  • Intensive Care Unit
  • World Health Organization
  • Observational Study
  • European Country

In a previous issue of Critical Care, Simon and colleagues [1] reported the incidence of death related to percutaneous tracheostomy (PT). Fatal complications occurred in 31% of cases during the procedure and in 49% of cases within the first week of the tracheostomy [1]. In a later issue of Critical Care, Rajendran and Hutchinson [2] suggested the use of a checklist, adapted from the World Health Organization (WHO) surgical safety checklist, to improve safety and reduce errors and harm related to the PT procedure in critical care. However, a recent observational study performed in 101 hospitals in Ontario, Canada, did not find any reduction in mortality or complications after the implementation of the WHO checklist in more than 100,000 surgical procedures [3].

PT is widely used in critical care, although no clinical guidelines have been developed to suggest the best practice for this invasive and risky procedure. Surveys on PT, performed in different European countries, have shown the presence of a shared clinical practice [4]. We think that, lacking clinical guidelines to provide the best available scientific evidence and to reduce inappropriate variation in PT practice, a careful analysis of different surveys may suggest to physicians the most common practice associated with PT. Table 1 shows shared clinical practice for PT from an analysis of seven national surveys performed in France (where 152 intensive care units participated in the survey), Germany (505), Italy (130), The Netherlands (63), Spain (100), Switzerland (48), and the UK (197).
Table 1

Shared clinical practice for percutaneous tracheostomy from an analysis of seven national surveys in Europe


Most common practice


Long-term mechanical ventilation, weaning failure, and upper airway obstruction


Ciaglia single dilator and guide-wire dilating forceps


7 to 15 days after intensive care unit admission

Involved physicians in percutaneous tracheostomy

Intensivists; ear, nose, throat specialist; and general surgeon

Neck ultrasound evaluation

Screening before the procedure to assess at-risk structure

Ventilation protocol

Largely used with volume-controlled ventilation

Sedation protocol

Largely used in association with local anesthesia, analgesia, and neuromuscular blocking

Airway management

Endotracheal tube in place

Fiberoptic bronchoscopy

Largely used

Diameter of fiberoptic bronchoscope

3 to 5 mm

Intraprocedural complications

Minor bleeding

The analysis was of seven national surveys performed in France (where 152 intensive care units participated in the survey), Germany (505), Italy (130), The Netherlands (63), Spain (100), Switzerland (48), and the UK (197).



percutaneous tracheostomy


World Health Organization.


Authors’ Affiliations

Department of Neurosciences, Reproductive and Odontosthomatological Sciences, University of Naples “Federico II”, Naples, Via Pansini 16 – 80100, Naples, Italy
Department of Surgical Sciences and Integrated Diagnostics-IRCCS San Martino IST, University of Genoa, L.go R. Benzi 16-1632, Genoa, Italy


  1. Simon M, Metschke M, Braune SA, Puschel K, Kluge S: Death after percutaneous tracheostomy: a systematic review and analysis of risk factors. Crit Care. 2013, 17: R258-10.1186/cc13085.PubMed CentralView ArticlePubMedGoogle Scholar
  2. Rajendran G, Hutchinson S: Checklist for percutaneous tracheostomy in critical care. Crit Care. 2014, 18: 425-10.1186/cc13833.PubMed CentralView ArticlePubMedGoogle Scholar
  3. Urbach DR, Govindarajan A, Saskin R, Wilton AS, Baxter NN: Introduction of surgical checklist in Ontario, Canada. N Engl J Med. 2014, 370: 1029-1038. 10.1056/NEJMsa1308261.View ArticlePubMedGoogle Scholar
  4. Vargas M, Servillo G, Arditi E, Brunetti I, Pecunia L, Salami D, Putensen C, Antonelli M, Pelosi P: Tracheostomy in intensive care unit: a national survey in Italy. Minerva Anestesiol. 2013, 79: 156-164.PubMedGoogle Scholar


© Vargas et al.; licensee BioMed Central Ltd. 2014

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