Comparison of manipulation between two different methods of percutaneous dilatational tracheostomy

Abstract

Objective To compare the manipulation of two different methods of percutaneous dilatational tracheostomy (PDT), the guidewire dilating forceps (Portex method) and the modified one- step dilation technique (Ciaglia Blue Rhino method, CBR method). Methods From March 2013 to February 2014, 48 patients eligible to meet the criteria of tracheostomy in ICU were collected and were divided into two groups at random. The length of time consumed for operation, amount of blood lost during operation and the operation complications were compared between two groups. The participant surgeons were asked which method they preferred, Portex or CBR. Results Of them, the mean age was 76.7 ± 11.6 years old, and 25 patients (52.1%) were male. The reasons for tracheotomy were the length of time needed for mechanical ventilation support expected to be longer than 2 weeks (n =30) , severe disturbance of consciousness (n =17) , and upper airway obstruction (n =1). The patients enrolled in the study were randomly divided into Portex and CBR groups. There were no significant differences in age, gender, APACHEⅡ score, the reason of tracheotomy, the length of time for mechanical ventilation support before tracheotomy, and the preoperative coagulation function between two groups. CBR method can easily be done with less operation time required than Portex [(5.9 ±4.3) min vs. (9.9 ±1.5) min, P<0.01], and had obviously fewer operation complications and less amount of blood lost than Portex method (P<0.05). The male surgeons with a slew of surgical practice were in preference to Portex, whereas female doctors with less work experience and without surgical practice preferred CBR. Conclusions The CBR method can easier be done and was better than the Portex method in minimizing operative trauma and reducing the complications, especially it can easily be accepted by female doctors with less work experience and without surgical practice and it is worth using widely in clinic. Key words: Tracheostomy; Percutaneous dilationaltracheostomy (PDT) Guide wire dilatingforceps (Portex); Improved one-step dilation technique, Ciaglia Blue Rhino method (CBR)