Single-step vs balloon dilatation tracheostomy: a pilot study on 20 tracheostomies

Introduction

The Ciaglia Blue Rhino percutaneous dilatational tracheostomy (PDT) technique, introduced in 1998 as a modification of the original procedure described in 1985, has been indicated as procedure of choice (level 2C) because of its technical simplicity and short procedure time. Recently, a modified balloon dilatation technique (Ciaglia Blue Dolphin) has been introduced with the intention to increase feasibility and safety. Here we report our initial experience in Ciaglia Blue Dolphin tracheostomy in comparison with a prospective control group of Ciaglia Blue Rhino procedures, which are actually the goal-standard in our ICU.

Methods

Twenty consecutively admitted patients in the Emergency Department ICU (Careggi Teaching Hospital, Florence, Italy) requiring percutaneous dilatational tracheostomy (PDT) were treated with Ciaglia Blue Dolphin (first 10, group D) and Ciaglia Blue Rhino (second 10, group R). Demographic, clinical and procedural data were collected. PDTs were all performed with bronchoscopic video guidance. The Mann-Whitney test was used to compare continuous variables.

Results

Patients of the two groups were similar for mean age (51.2 and 53.4 years old, respectively), body mass index (25.1 vs 24.8, respectively) and severity of illness (SAPS II: 44.3 vs 45.4, respectively). Group D showed a significant higher procedural duration (measured from tracheal puncture to tracheostomy tube positioning) than group R (4.3 minutes vs 2.6 minutes; P < 0.01).

Conclusions

Despite recent reports in literature, we did not found substantial advantage in the use of Ciaglia Blue Dolphin with respect to the wider accepted Ciaglia Blue Rhino. Moreover, the higher cost of the new kit should be taken into consideration. In our opinion, complications such as tracheal posterior wall injury, pneumothorax, and pneumomediastinum can be avoided using the bronchoscopic video guidance.