Percutaneous dilational tracheostomy as the preferred method of airway management

Abstract

Tracheostomy is frequently required for the management of patients requiring prolonged mechanical ventilatory support. Open tracheostomy performed in the operating room or at the bedside has been the standard. Percutaneous tracheostomy was first described in 1955 by Shelden et all as an alternative technique that could be performed at the bedside.l The procedure involved blind cannulation of the trachea with a bladed instrument and was not widely accepted. A number of variations on the percutaneous method have been described, but none have gained widespread clinical acceptance.2-4 Toy and Weinstein* were the first to describe a percutaneous technique that used a guide-dilator complex to allow for safer carmulation of the trachea. Using a modification of Toy’s method, Ciaglia and his colleagues introduced the percutaneous dilational tracheostomy (PDT), which uses a series of dilators passed over a flexible Seldinger wire.5a6 Ciaglia and others have reported very favorable results with PDT.6-10 In direct comparison studies, complication rates for PDT compared favorably with the complication rates for open tracheostomy.“-15 Early criticism of PDT came because advocates had not provided convincing data on the procedural complications and the incidence of tracheal stenosis. A number of more recent prospective studies show procedural complications and stenosis rates that are lower than those reported for open tracheostomy.‘“-l9 There is now a large body of literature that clearly