Dr Leung Yuen Wah, Winnie
Department of Anaesthesia and Intensive Care, Yan Chai Hospital; December 2001
Abstract
Tracheostomy is one of the oldest surgical procedures in medical history, and reference to it can be found 4000 years ago in the Egyptians. It is a commonly performed surgical procedure in the critically ill who requires prolonged mechanical ventilation. Relative to translaryngeal intubation, tracheostomy affords greater patient comfort, more effective pulmonary toilet, and increased airway security. The standard method of performing tracheostomy was described in 1909 by Jackson. The percutaneous method was first reported by Shelden in 1955, and modified by Toye and Weinstein
in 1965. The real success did not occur until 1985, when Ciaglia introduced a modification of Toye’s technique that involved serial dilation of the trachea over a Seldinger wire to create a stoma, with no complications in the initial 26 patients. The complication rates and economics of tracheostomy tube insertion via the percutaneous route compare favourably and may even be superior to those with standard operative tracheostomy, resulting in its escalating popularity in intensive care units in the last decade. The term percutaneous tracheostomy does not define a single technique. There are at least four different versions: Ciaglia’s progressive dilatation with multiple dilator technique (PDT), the Grigg’s guide wire dilating forceps technique (GWDF), the recently introduced Ciaglia’s single dilator trade name "Blue Rhino" (CBR), and the mostly abandoned Rapitrac technique. This
article will provide an overview of the former three percutaneous techniques, and to review the currently available evidence to support the safety and cost effectiveness of the procedure. Lastly, data collected from the twenty-three patients who underwent percutaneous tracheostomy in Yan Chai Hospital’s Intensive Care Unit will be presented.