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Biomechanical experimental evaluation of percutaneous tracheostomy to compare the Ciaglia and Griggs techniques

Introduction

The aim of our study was to create a method for biomechanical experimental evaluation of the percutaneous tracheostomy (PCT) technique and perform its assessment in order to minimize possible trauma of cervical trachea inherent in this procedure. Nowadays two techniques of PCT, Ciaglia and Griggs, are employed.

Every technique is based on gradual tearing of the hole in the cervical trachea by specially designed dilators. We suggested that biomechanical study of the different stages of PCT will help to understand all these processes and to clarify the reasons for traumatic perioperative complications.

Materials and methods

PCT by the Ciaglia technique (n = 10) and by the Griggs technique (n = 10) were performed on fresh dead pigs with body mass of 115 ± 3 kg. A Portex set of instruments was used for the Griggs technique and a Cook set of instruments for the Ciaglia technique. During PCT special measurements were performed with the help of an electronic dynamometer (MRC): piercing force applied on needle cannula, penetrating force applied on 14 F dilator, pulling force applied on branches of Griggs dilating forceps, pushing force applied on Ciaglia Blue Rhino dilator, pushing force applied on distal end of tracheostomy tube no. 8 with introducer (Portex set) and pushing force applied on distal end of tracheostomy tube no. 8 loaded on dilator (Cook set). On the base of these measurements calculation of energy spent for these stages of PCT was made. At the end of each experiment evaluation of cervical trachea was performed to measure the size of tracheotomy performed by the Ciaglia and Griggs dilators.

Results

Application of the Ciaglia dilator requested 1.54 times more energy than the Griggs dilator forceps (P < 0.05). Formation of tracheotomy by the Ciaglia dilator was more exact than by Griggs forceps due to special markings on the dilator. The work with Griggs dilating forceps requested more experience due to the absence of any markings on the dilator. The most dangerous moments of PCT for laceration of the cervical trachea were: dilation of hole in the cervical trachea in the Griggs technique and insertion of the tracheostomy tube loaded on the dilator in the Ciaglia technique. The macroscopic appearance and transverse diameter of tracheotomy performed by the Ciaglia and Griggs techniques were the same despite the different instruments used for dilation (P < 0.05).

Conclusions

PCT by the Ciaglia and Griggs techniques has almost similar biomechanical characteristics. In spite of the difference in the design of dilators the final result of the two techniques is the same. Both of them have dangerous moments. In order to prevent laceration of the cervical trachea during PCT some improvements must be made in instrumentation.

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Rozin, I., Croitoru, M., Radinsky, E. et al. Biomechanical experimental evaluation of percutaneous tracheostomy to compare the Ciaglia and Griggs techniques. Crit Care 9, P116 (2005). https://doi.org/10.1186/cc3179

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Keywords

  • Experimental Evaluation
  • Special Marking
  • Special Measurement
  • Biomechanical Study
  • Transverse Diameter