Traqueotomía percutánea por dilatación con el método Ciaglia Blue Dolphin®

Abstract

ObjectiveTo describe the perioperative and postoperative complications in critically ill patients requiring percutaneous tracheostomy using the Ciaglia Blue Dolphin® technique. DesignA prospective, observational, cohort study was carried out. ScopeTwo medical-surgical Intensive Care Units. PatientsAdult patients subjected to prolonged mechanical ventilation. InterventionPercutaneous tracheostomy using Ciaglia Blue Dolphin® with an endoscopic guide. VariablesDemographic variables, intraoperative and postoperative complications, and Intensive Care Unit and ward mortality were recorded. ResultsSeventy patients were included. Age: 68.6±12 years (68.6% males). APACHE II score: 23.5±8.7. Duration of mechanical ventilation prior to percutaneous tracheostomy: 14.3±5.5 days. Perioperative complications were recorded in 25 patients. In 23 of them the complications were mild: difficulty inserting the tracheostomy cannula (n=10), mild bleeding (n=7), partial atelectasis (n=3), cuff leak (n=2), and technical inability to complete the procedure (switch to Ciaglia Blue Rhino®) (n=1). Severe complications were recorded in 2 patients: severe bleeding that forced completion of the procedure via surgical tracheostomy (n=1), and false passage with desaturation (n=1). None of the complications proved life-threatening. Eleven complications occurred in the learning curve. As postoperative complications, mild peri-cannula bleeding was seen in 2 patients. ConclusionsPercutaneous tracheostomy using the Ciaglia Blue Dolphin® technique with an endoscopic guide is a safe procedure. As with other procedures, the learning curve contributes to increase the incidence of complications. Potential benefits versus other percutaneous tracheostomy techniques should be explored by randomized trials.