Review Article
Pitfalls in Percutaneous Dilational Tracheostomy Using the Ciaglia® One-Step Technique
Abstract
Surgical tracheostomy was first described in 1909. Since then, it has become a standard procedure for patients requiring prolonged mechanical ventilation. More recently, bedside percutaneous tracheostomy has been shown to be as safe and effective as the surgical technique, but with the added advantage of also being technically straightforward and cost-efficient. Partly because of this, percutaneous tracheostomy is now being performed by nonsurgeon intensivists. However, the relative ease of the procedure may mask many potential pitfalls that can result in morbidity. As such, it is important for all intensivists to be familiar with the steps and potential pitfalls of this procedure. This is an evidence-based review of the common pitfalls associated with the Ciaglia® one-step percutaneous tracheostomy technique, the method most commonly utilized for percutaneous tracheostomy insertion in the United States.
Key Points
* Percutaneous tracheostomy is an established, safe, cost-effective option for most patients.
* This procedure should be used with caution in patients who have elevated intracranial pressure, are hypercarbic or acidemic, or who have a severely impaired ability to absorb oxygen.
* Although controversial, use of continuous bronchoscopy may decrease the incidence of esophageal injury, ensure placement of the tracheostomy tube in the accurate position in the trachea, and facilitate fiberoptic reintubation in cases of accidental extubation.
* The procedure can be aborted at any point prior to dilation of the trachea with the Blue Rhino® dilator itself, and can also be temporarily halted to allow the patient to be oxygenated and ventilated as needed.
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