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Percutaneous tracheostomy: comparison of Ciaglia and Griggs techniques.

Kost KM - Crit Care (2000)

Bottom Line: Although relative complication rates for the two techniques are not significantly different, both procedures are performed in a 'blind' fashion, without the benefit of a bronchoscope.Operative time is reported to be shorter with the Griggs technique, but this finding is unlikely to hold true for the single dilator technique, which reduces procedure time to less than 15 min.This author's experience with bedside endoscopic PCT using the single dilator indicates that it is a safe, rapid and cost-effective procedure with a low complication rate.

View Article: PubMed Central - HTML - PubMed

Affiliation: McGill University, Montreal, Quebec, Canada. kmkost@yahoo.com

ABSTRACT
Endoscopic percutaneous dilatational tracheostomy is at least as safe as standard open tracheostomy in the operating room (OR). Recently, a single dilator was introduced to accomplish dilatation of the tracheal aperture in one step, thus obviating the need for multiple graduated dilators. Experience with endoscopic percutaneous tracheostomy (PCT) using the single dilator in 40 patients to date supports the premise that the procedure is safe, rapid, and technically simple. In the study by Añon et al, two very different techniques, are compared: the Ciaglia percutaneous dilatational tracheostomy technique using multiple dilators and the Griggs percutaneous technique using guidewire-dilating forceps. Although relative complication rates for the two techniques are not significantly different, both procedures are performed in a 'blind' fashion, without the benefit of a bronchoscope. The reported incidence of serious complications in this study is high, and almost certainly avoidable with the addition of direct bronchoscopic visualization. Operative time is reported to be shorter with the Griggs technique, but this finding is unlikely to hold true for the single dilator technique, which reduces procedure time to less than 15 min. This author's experience with bedside endoscopic PCT using the single dilator indicates that it is a safe, rapid and cost-effective procedure with a low complication rate.

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Related in: MedlinePlus

The guiding catheter is placed over the guidewire, forming the				unit over which the single dilator is introduced. Note the bronchoscope within				the ETT, trans-illuminating the incision and allowing direct visualization of				the procedure.
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Figure 1: The guiding catheter is placed over the guidewire, forming the unit over which the single dilator is introduced. Note the bronchoscope within the ETT, trans-illuminating the incision and allowing direct visualization of the procedure.

Mentions: The procedure, using the single dilator, is performed with the head extended on the chest, using a standard preparation and drape. The patient is ventilated on 100% oxygen and vital signs are continuously monitored. Local anesthesia augmented by intravenous sedation is required. A 1.5 cm incision is placed one to two fingerbreadths above the cricoid cartilage, and the subcutaneous fat is separated using a curved hemostat. At this point, a flexible bronchoscope is inserted and aligned with the tip of the endotracheal tube (ETT). The bronchoscope and ETT are slowly withdrawn until the incision is maximally trans-illuminated, allowing continuous visualization of the entire procedure. A 14-gauge Teflon catheter introducer needle is inserted between the first and second, or second and third tracheal rings. A J-wire threaded through the intracath allows placement of an introducer dilator. This initial enlargement of the tracheal aperture facilitates positioning of the guiding catheter over the J-wire (Fig. 1). It is this J-wire/guiding catheter unit that forms the backbone over which the single dilator is inserted in an arc-like manner, accomplishing sufficient dilatation in one step (Fig. 2). In contrast, when using the multiple dilator kit, the tracheal aperture is sequentially enlarged using a series of graduated dilators. The final step in both techniques involves inserting a preloaded tracheostomy tube over the J-wire/guiding catheter unit (Fig. 3).


Percutaneous tracheostomy: comparison of Ciaglia and Griggs techniques.

Kost KM - Crit Care (2000)

The guiding catheter is placed over the guidewire, forming the				unit over which the single dilator is introduced. Note the bronchoscope within				the ETT, trans-illuminating the incision and allowing direct visualization of				the procedure.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC137251&req=5

Figure 1: The guiding catheter is placed over the guidewire, forming the unit over which the single dilator is introduced. Note the bronchoscope within the ETT, trans-illuminating the incision and allowing direct visualization of the procedure.
Mentions: The procedure, using the single dilator, is performed with the head extended on the chest, using a standard preparation and drape. The patient is ventilated on 100% oxygen and vital signs are continuously monitored. Local anesthesia augmented by intravenous sedation is required. A 1.5 cm incision is placed one to two fingerbreadths above the cricoid cartilage, and the subcutaneous fat is separated using a curved hemostat. At this point, a flexible bronchoscope is inserted and aligned with the tip of the endotracheal tube (ETT). The bronchoscope and ETT are slowly withdrawn until the incision is maximally trans-illuminated, allowing continuous visualization of the entire procedure. A 14-gauge Teflon catheter introducer needle is inserted between the first and second, or second and third tracheal rings. A J-wire threaded through the intracath allows placement of an introducer dilator. This initial enlargement of the tracheal aperture facilitates positioning of the guiding catheter over the J-wire (Fig. 1). It is this J-wire/guiding catheter unit that forms the backbone over which the single dilator is inserted in an arc-like manner, accomplishing sufficient dilatation in one step (Fig. 2). In contrast, when using the multiple dilator kit, the tracheal aperture is sequentially enlarged using a series of graduated dilators. The final step in both techniques involves inserting a preloaded tracheostomy tube over the J-wire/guiding catheter unit (Fig. 3).

Bottom Line: Although relative complication rates for the two techniques are not significantly different, both procedures are performed in a 'blind' fashion, without the benefit of a bronchoscope.Operative time is reported to be shorter with the Griggs technique, but this finding is unlikely to hold true for the single dilator technique, which reduces procedure time to less than 15 min.This author's experience with bedside endoscopic PCT using the single dilator indicates that it is a safe, rapid and cost-effective procedure with a low complication rate.

View Article: PubMed Central - HTML - PubMed

Affiliation: McGill University, Montreal, Quebec, Canada. kmkost@yahoo.com

ABSTRACT
Endoscopic percutaneous dilatational tracheostomy is at least as safe as standard open tracheostomy in the operating room (OR). Recently, a single dilator was introduced to accomplish dilatation of the tracheal aperture in one step, thus obviating the need for multiple graduated dilators. Experience with endoscopic percutaneous tracheostomy (PCT) using the single dilator in 40 patients to date supports the premise that the procedure is safe, rapid, and technically simple. In the study by Añon et al, two very different techniques, are compared: the Ciaglia percutaneous dilatational tracheostomy technique using multiple dilators and the Griggs percutaneous technique using guidewire-dilating forceps. Although relative complication rates for the two techniques are not significantly different, both procedures are performed in a 'blind' fashion, without the benefit of a bronchoscope. The reported incidence of serious complications in this study is high, and almost certainly avoidable with the addition of direct bronchoscopic visualization. Operative time is reported to be shorter with the Griggs technique, but this finding is unlikely to hold true for the single dilator technique, which reduces procedure time to less than 15 min. This author's experience with bedside endoscopic PCT using the single dilator indicates that it is a safe, rapid and cost-effective procedure with a low complication rate.

Show MeSH
Related in: MedlinePlus