Bedside Percutaneous Tracheostomy: Clinical Comparison of Griggs and Fantoni Techniques

Abstract

Elective tracheostomy is widely considered the preferred airway management of patients on long-term ventilation. In addition to open tracheostomy, a number of percutaneous procedures have been introduced during the last two decades, among them techniques according to Griggs (guidewire dilating forceps, or GWDF) and to Fantoni (translaryngeal tracheostomy, or TLT). The aim of the study was to evaluate these two techniques in terms of perioperative complications, risks, and benefits in critically ill patients. A series of 100 critically ill adult patients on long-term ventilation underwent elective percutaneous tracheostomy, either according to the Griggs (n = 50) or Fantoni (n = 50) technique. Tracheostomy was performed under general anesthesia at the patient's bedside. The mean (+/-SD) operating times were short, 9.2 +/- 3.9 minutes (TLT) and 4.8 +/- 3.7 minutes (GWDF) on average. Perioperative complications were noted in 4% of patients during either TLT or GWDF and included massive bleeding, mediastinal emphysema, posterior tracheal wall injury, and pretracheal placement of the tracheostomy tube. With regard to oxygenation, pre- and postoperative arterial oxygen tension divided by the fraction of inspired oxygen (PaO2/FiO2) ratios did not vary significantly, and no perioperative hypoxia was noted regardless of the technique used. We conclude that both TLT and GWDF represent attractive, safe alternatives to conventional tracheostomy or other percutaneous procedures if carefully performed by experienced physicians and under bronchoscopic control.

Gastrointestinal Emergencies in Cardiac Surgery

“…The most devastating complication is intestinal ischemia with a high mortality varying from 64 to 80% [18, 19]. In fact, ischemic colitis was a cause of death in 3 out of 4 patients who died of GI complications in our series.…”

“…Although rare, GI complications following coronary revascularization are invariably associated with high morbidity and mortality [5, 18, 19]. The most common include GI bleeding (especially if anticoagulants are administered), bowel ischemia and pancreatitis.…”

Prospective evaluation of the retrograde percutaneous translaryngeal tracheostomy (Fantoni procedure) in a surgical intensive care unit: Technique and results of the Fantoni tracheostomy

“…[1][2][3][4] Similar complications were observed with the percutaneous method of Griggs, in which the tracheostomy is accomplished by widening the gap between the cartilaginous rings using a forceps. [5][6][7] In these cases, injury of the posterior tracheal wall is reported even more frequently (2% to 5%). Griggs' procedure does have the advantage, however, of infrequent cannula malposition (0% to 2%) and a shorter intervention time compared with the standard method.…”

“…Imami et al 16 reported a decrease of the SaO 2 to less than 90% in 15% of patients undergoing a bronchoscopically controlled tracheostomy of Ciaglia despite periinterventional ventilation with an FiO 2 of 1.0. With the Fantoni method, hypoxia is described in up to 6% of the cases 6 because of the need for removal of the ventilation tube. For this reason, the Fantoni tracheostomy was only performed if the pre-interventional FiO 2 was less than 0.8.…”

Fantoni’s Tracheostomy using Catheter High Frequency Jet Ventilation

“…It is based on the translaryngeal (retrograde) principle of tracheal dilation by the tip built into the tra cheostomic introductory tube and a cannula from the tra chea transcutaneously outwards (2)(3)(4). The advantage of TLT is the technique of minimal invasiveness and minimal damage to the trachea, which can be a problem at surgical and punctural dilatation tracheostomy (5).…”