There are several other PCT techniques described, many of which are fundamentally different from each other. Comparisons are important in resolving safety issues.
Two very different techniques were compared in the study by Añon et al , primarily in terms of complications and operative times. Although an interesting study, the report suffers from inherent weaknesses that raise questions about the validity of the conclusions reached.
First, the technical details provided are sparse, making it unclear exactly how the procedures were performed. Reviewing these details is important because they may have a direct bearing on the incidence of certain complications. In the Ciaglia technique, after the initial incision the subcutaneous fat is spread horizontally and no attempt is made to carry the dissection further, which could indeed result in bleeding from the thyroid gland. The authors mention 'repositioning' the ETT to just below the vocal cords. Without the use of a bronchoscope for trans-illumination through a previously made incision, how can this be done safely without a significant risk of accidental extubation? Both techniques were performed in a 'blind' manner, without the use of a bronchoscope. There is increasing evidence [7,8] that endoscopy, which allows direct step-by-step visualization of the procedure, significantly reduces the incidence of serious complications such as posterior tracheal tears, false passage, pneumothorax and subcutaneous emphysema. Indeed, in the article by Añon et al , a total of 15 complications occurred in 10 out of 63 patients. Six of these complications occurred in two patients, both of whom had tracheal tears; as a consequence of these tracheal tears, both patients also suffered a deterioration in oxygen saturation and developed subcutaneous emphysema. A false passage developed in another patient. It is likely that all seven aforementioned complications could have been avoided with bronchoscopy, which would have allowed visualization of the posterior tracheal wall and prevented the tears and creation of a false passage. This would have reduced the complication rate from 15 out of 63 (23%) to eight out of 15 (13%).
Whereas the Ciaglia technique involves blunt dilatation of an initial tracheal aperture by displacing adjacent tissue, in the Griggs technique dilatation of the tracheal aperture is achieved by passing a dilating forceps over the guidewire, into the trachea. Opening these forceps, which resemble a nasal speculum, forcibly dilates the tracheal aperture and any intervening tissue. Because the desirable tracheostomy site (between first and second or between second and third tracheal rings) often corresponds to the anatomical location of the thyroid isthmus, the latter may be torn on opening the dilating forceps, thus increasing the risk of bleeding. Three out of the four cases of hemorrhage occurred in the Griggs guidewire dilating forceps group. Indeed, the potential also exists for over-zealous insertion of the forceps through the posterior tracheal wall and even into the esophagus, particularly because the procedure is blind.
The second shortcoming of the study by Añon et al  is the lack of long-term follow up, and therefore the incidence of complications such as tracheal stenosis and tracheomalacia is unknown. Review of the literature suggests a low incidence of these complications in the endoscopic dilatational PCT technique.
Finally, reduced procedure time is often touted as an additional advantage of bedside PCT. Añon et al  noted a significantly lower procedure time in the Griggs guidewire dilating forceps technique compared with the Ciaglia technique employing multiple dilators. Although this may be so, it is unlikely that this difference would hold with the new Ciaglia single dilator kit. My experience indicates that the procedure can easily be performed in less than 15 min.