Early and late outcome after single step dilatational tracheostomy versus the guide wire dilating forceps technique: a prospective randomized clinical trial

Abstract

PurposePercutaneous tracheostomy is frequently performed in long-term ventilated patients in the intensive care unit (ICU). Unfortunately, despite many years of experience, the optimal technique is still unknown, especially considering the occurrence of late complications. The purpose of this study was to determine which of the two most frequently used percutaneous tracheostomy techniques performs best with the emphasis on late complications.MethodsThis prospective randomized trial involved 120 patients, comparing two techniques of percutaneous tracheostomy, the guide wire dilating forceps (GWDF) and the single step dilatational tracheostomy (SSDT) technique.ResultsSixty patients in each group underwent a percutaneous tracheostomy and were followed for up to 3 months after decannulation. The majority of complications in both groups were minor (58.3% in the GWDF group and 61.7% in the SSDT group). We found a trend towards more major perioperative complications in the GWDF group versus the SSDT group, 10.0 versus 1.7% (p = 0.06). One patient in the SSDT group developed a significant tracheal stenosis. However, this may also have been related to prolonged translaryngeal intubation. Results of magnetic resonance imaging (MRI) investigations showed only minor tracheal changes. Only 37.5% of patients in the GWDF group and 31.8% in the SSDT group had no complaints after their percutaneous tracheostomy.ConclusionCompared with the GWDF, the SSDT shows a trend toward less major perioperative complications with a comparable long-term outcome.

Comparison between ultrasound- and bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients: A retrospective cohort study

“…The median procedure length was shorter in the US group, with the length of bronchoscopy-guided PDT being similar to that of previous [14][15][16][17][18][19][20][21][22][23] 13 [10][11][12][13][14][15][16][17][18][19][20][21][22] .004…”

“…Guinot et al [13] observed an overall complication rate of 33% in a population of 50 obese and nonobese patients submitted to US-guided tracheostomy, with bleeding accounting for 6%, surgical site infection for 2%, desaturation for 6%, and hypotension for 6%. In a trial of 120 patients submitted to bronchoscopy-guided PDT, 15% of patients had minor blood loss, 2.5% had transient hypoxemia, and 15% had the endotracheal tube punctured [18]. In the 2 largest retrospective cohorts previously published on the topic, including a total of 4162 patients in the analyses, the major complication rates were very low, ranging from 0.38% to 1.4% [2,19].…”

Impact of percutaneous dilatational tracheostomy in brain injured patients

“…Recent studies show rates of 1% for major complications and highly variable rates (up to 60%) of minor complications in PDT [14,15]. Our series resulted in a comparable rate (0.35%) of major complications, including one life-threating vascular injury.…”

The Role of Cricothyrotomy, Tracheostomy, and Percutaneous Tracheostomy in Airway Management

“…33 Several randomized, longitudinal trials comparing the single dilation Ciaglia technique and the Griggs technique have also been conducted. [34][35][36][37][38] A meta-analysis of these trials found evidence of superiority of the Ciaglia technique using a combined endpoint representing procedural difficulties and bleeding. 39 The Role of Cricothyrotomy, Tracheostomy…”