A novel technique for safe blind percutaneous tracheotomy: retrospective case-series study on three hundred eighty-six patients

Abstract

BackgroundGriggs’ technique with assisting tools for bedside percutaneous tracheotomy (PDT) is safe and fast and carries few complications in expert hands. Assisting tools are not routinely available in many ICUs. The study aims to evaluate the impact of a novel technique for blind percutaneous tracheotomy on success rate, duration of the procedure, and rate of complications. This retrospective case-series study was conducted in the different intensive care units in Alexandria University Hospitals. Three hundred eighty-six patients were recruited from 1 January 2018 to 31 December 2021. After skin incision and blunt pre-tracheal dissection, a needle was inserted to access the airway, transfixing the endotracheal tube (ETT). A change in the alignment of the needle tip inside the trachea from caudal to cranial accompanied the withdrawal of the ETT off the trachea. In situ caudal needle redirection for subsequent guidewire passage distally into the trachea was done. The rest of the procedure was continued as Griggs’ technique.ResultsThe success rate was 100%. The procedure duration (in seconds) was 125.73±19.52. No procedure-related deaths or major intra-operative complications were encountered. Only three patients developed pneumothorax and subcutaneous emphysema, managed by intercostal tube insertion.ConclusionsThe novel technique for blind percutaneous tracheotomy was successful with no significant procedure-related complications. The duration of the procedure was comparable to the literature.