Prevention of tracheal cartilage injury with modified Griggs technique during percutaneous tracheostomy — Randomized controlled cadaver study

Abstract

Modified Griggs technique decreased the risk of tracheal cartilage injury significantly in our cadaver study. This observation may explain the decreased number of late tracheal stenosis after application of the modified Griggs method.

Percutaneous tracheostomy: Comparison of three different methods with respect to tracheal cartilage injury in cadavers—Randomized controlled study

“…Although there are several studies, meta-analyses and excellent reviews which compare the different PDT techniques ( 6 , 30 , 44 – 47 ), there is still no consensus between physicians on which technique has the lowest major complication rate. Our aim in this study was to compare the two most widely used PDT techniques—namely the Griggs’ and the Single Dilator—and also our previously suggested modification of Griggs’ version ( 21 ) in cadavers, in respect of cartilage injury, which is believed to take important part in the development of tracheal stenosis ( 48 , 49 ).…”

“…We have suggested a modification to the classical Griggs’ method in order to decrease the complications of PDT in our previous study ( 21 ). We have found that this modification caused a remarkable decrease in the number of injured tracheal cartilages.…”

“…Modified Griggs’ technique: a maximum 50 mm-wide skin incision, surgical pretracheal tissue preparation, and careful, visualized bidirectional (transverse and longitudinal) intercartilaginous forceps dilation of tracheal wall were performed ( 21 ). The wider horizontal skin incision provided enough space for secure pretracheal preparation until the tracheal wall could be visualized as well as palpated in our modified technique.…”

“…As there is a possible causative relationship between the fracture of the cartilage during the PDT procedure and the aforementioned tracheal stenosis, in this study we wanted to investigate how common cartilage fracture is when performing PDT on cadavers with the two most common methods, namely Griggs’ and single dilator (Rhino), and we also reevaluated and compared our previously described modified Griggs’ method (in which we make a wider incision, blunt preparation, and bidirectional forceps dilation of the tracheal wall, e.g. standard horizontal and novel vertical) with them ( 21 ). The further late complications such as tracheomalacia, tracheoinominate artery fistula and tracheoesophageal fistula occur each in <1%.…”

Az antropometriai paraméterek szerepe a cadaveren végzett percutan tracheostomás módszerekben

“…Az 1985-ben Ciaglia által leírt, növekvő átmérőjű tágító eszközöket alkalmazó módszer széles körben elterjedt, majd számos módosítást követően új technikák láttak napvilágot [9]. Hazánkban a leggyakrabban használt percutan tracheostomás eljárások az 1999-ben Ciaglia saját módszerét módosítva kialakított, folyamatos tágítást alkalmazó Blue Rhino-(CBR; Cook Critical Care, Bloomington, IL, USA) technika és a Griggs által 1990-ben leírt, speciális tágító eszközt (Griggs-eszköz) alkalmazó módszer, valamint annak a jelen cikk témavezetője által kidolgozott és tesztelt módosítása [10][11][12]. A kanül behelyezése mind a sebészi, mind a percutan technikák esetében az 1-2., 2-3. vagy 3-4. tracheaporcok közötti résbe javasolt.…”