Clinical review: Percutaneous dilatational tracheostomy

Mariam A Al-Ansari,Mohammed H Hijazi

doi:10.1186/cc3900

Abstract

As the number of critically ill patients requiring tracheotomy for prolonged ventilation has increased, the demand for a procedural alternative to the surgical tracheostomy (ST) has also emerged. Since its introduction, percutaneous dilatational tracheostomies (PDT) have gained increasing popularity. The most commonly cited advantages are the ease of the familiar technique and the ability to perform the procedure at the bedside. It is now considered a viable alternative to (ST) in the intensive care unit. Evaluation of PDT procedural modifications will require evaluation in randomized clinical trials. Regardless of the PDT technique, meticulous preoperative and postoperative management are necessary to maintain the excellent safety record of PDT.

Highlights

Tracheostomy is one of the oldest surgical procedures, described in ancient books of medicine [1]
In the second section we focus on evidencebased recommendations, using the best available evidence, regarding issues such as modifications to percutaneous dilatational tracheostomy (PDT) procedures designed to enhance patient safety and timing of performance in the intensive care units (ICUs) [5]
Kahveci and coworkers [56] reported the result of their prospective randomized study conducted to compare use of the cuffed oropharyngeal airway (COPA) and laryngeal mask airway (LMA) devices during PDT to maintain ventilation

Summary

Introduction

Tracheostomy is one of the oldest surgical procedures, described in ancient books of medicine [1]. A technique of performing percutaneous dilatational tracheostomy (PDT) over a guidewire was first described by Ciaglia in 1985. It is increasingly being performed in intensive care units (ICUs) at the bedside. The incision in PDT is small, the tracheostomy tube is fitted tightly against the stoma, and less dissection and damage to tissue occur These advantages are probably responsible for the favourable outcomes described in short-term and long-term follow-up studies of patients undergoing PDT [15,16,17], including fewer wound complications (such as bleeding and infection) and an aesthetically more favourable scar. Summary of trials comparing surgical tracheostomy and PDT in intensive care patients

Procedure

Conclusion

Findings

Jackson C