World Journal of Surgery

, Volume 37, Issue 7, pp 1633–1646 | Cite as

Evolution of Percutaneous Dilatational Tracheostomy—A Review of Current Techniques and Their Pitfalls

  • Jonathan Cools-Lartigue
  • Ali Aboalsaud
  • Heather Gill
  • Lorenzo Ferri


Tracheostomy is the most commonly performed surgical procedure in critically ill patients with acute respiratory failure. While few absolute indications exist, this procedure is widely used in patients with upper respiratory obstruction and those requiring long-term mechanical ventilation. The traditional approach to tracheostomy has been an open procedure performed in the operating room. This method is associated with an increased rate of complications and costs. Accordingly, percutaneous bedside tracheostomy procedures have largely replaced the traditional operative approach at many institutions. Numerous methods for percutaneous tracheostomy have thus emerged. However, the benefits of one technique versus another have not been well demonstrated. In this article, we review the evidence supporting the use of percutaneous tracheostomy procedures over the traditional operative approach. Furthermore, we review the currently available and emerging methods by which percutaneous tracheostomy can be performed. In addition, we highlight the available evidence concerning the safety and complication rates of each technique.


  1. 1.
    Wood DE (1996) Tracheostomy. Chest Surg Clin N Am 6:749–764PubMedGoogle Scholar
  2. 2.
    Kollef MH, Ahrens TS, Shannon W (1999) Clinical predictors and outcomes for patients requiring tracheostomy in the intensive care unit. Crit Care Med 27:1714–1720PubMedCrossRefGoogle Scholar
  3. 3.
    Heffner JE (2001) The role of tracheotomy in weaning. Chest 120:477S–481SPubMedCrossRefGoogle Scholar
  4. 4.
    Cox CE, Carson SS, Holmes GM et al (2004) Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993–2002. Crit Care Med 32:2219–2226PubMedGoogle Scholar
  5. 5.
    De Leyn P, Bedert L, Delcroix M et al (2007) Tracheotomy: clinical review and guidelines. Eur J Cardiothorac Surg 32:412–421PubMedCrossRefGoogle Scholar
  6. 6.
    Bhatti N, Tatlipinar A, Mirski M et al (2007) Percutaneous dilation tracheotomy in intensive care unit patients. Otolaryngol Head Neck Surg 136:938–941PubMedCrossRefGoogle Scholar
  7. 7.
    Durbin CG Jr (2005) Techniques for performing tracheostomy. Respir Care 50:488–496PubMedGoogle Scholar
  8. 8.
    Shelden CH, Pudenz RH, Freshwater DB et al (1955) A new method for tracheotomy. J Neurosurg 12:428–431PubMedCrossRefGoogle Scholar
  9. 9.
    Ciaglia P, Firsching R, Syniec C (1985) Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report. Chest 87:715–719PubMedCrossRefGoogle Scholar
  10. 10.
    Higgins KM, Punthakee X (2007) Meta-analysis comparison of open versus percutaneous tracheostomy. Laryngoscope 117:447–454PubMedCrossRefGoogle Scholar
  11. 11.
    Kost KM (2005) Endoscopic percutaneous dilatational tracheotomy: a prospective evaluation of 500 consecutive cases. Laryngoscope 115:1–30PubMedCrossRefGoogle Scholar
  12. 12.
    Kornblith LZ, Burlew CC, Moore EE et al (2011) One thousand bedside percutaneous tracheostomies in the surgical intensive care unit: time to change the gold standard. J Am Coll Surg 212:163–170PubMedCrossRefGoogle Scholar
  13. 13.
    Grigo AS, Hall ND, Crerar-Gilbert AJ et al (2005) Rigid bronchoscopy-guided percutaneous tracheostomy. Br J Anaesth 95:417–419PubMedCrossRefGoogle Scholar
  14. 14.
    Beiderlinden M, Groeben H, Peters J (2003) Safety of percutaneous dilational tracheostomy in patients ventilated with high positive end-expiratory pressure (PEEP). Intensive Care Med 29:944–948PubMedCrossRefGoogle Scholar
  15. 15.
    Barba CA, Angood PB, Kauder DR et al (1995) Bronchoscopic guidance makes percutaneous tracheostomy a safe, cost-effective, and easy-to-teach procedure. Surgery 118:879–883PubMedCrossRefGoogle Scholar
  16. 16.
    Griggs WM, Worthley LI, Gilligan JE et al (1990) A simple percutaneous tracheostomy technique. Surg Gynecol Obstet 170:543–545PubMedGoogle Scholar
  17. 17.
    Fantoni A, Ripamonti D (1997) A non-derivative, non-surgical tracheostomy: the translaryngeal method. Intensive Care Med 23:386–392PubMedCrossRefGoogle Scholar
  18. 18.
    Bodenham A, Diament R, Cohen A et al (1991) Percutaneous dilational tracheostomy. A bedside procedure on the intensive care unit. Anaesthesia 46:570–572PubMedCrossRefGoogle Scholar
  19. 19.
    Muhammad JK, Major E, Patton DW (2000) Evaluating the neck for percutaneous dilatational tracheostomy. J Craniomaxillofac Surg 28:336–342PubMedCrossRefGoogle Scholar
  20. 20.
    Kilic D, Findikcioglu A, Akin S et al (2011) When is surgical tracheostomy indicated? Surgical “U-shaped” versus percutaneous tracheostomy. Ann Thorac Cardiovasc Surg 17:29–32PubMedCrossRefGoogle Scholar
  21. 21.
    Gysin C, Dulguerov P, Guyot JP et al (1999) Percutaneous versus surgical tracheostomy: a double-blind randomized trial. Ann Surg 230:708–714PubMedCrossRefGoogle Scholar
  22. 22.
    Khalili TM, Koss W, Margulies DR et al (2002) Percutaneous dilatational tracheostomy is as safe as open tracheostomy. Am Surg 68:92–94PubMedGoogle Scholar
  23. 23.
    Massick DD, Yao S, Powell DM et al (2001) Bedside tracheostomy in the intensive care unit: a prospective randomized trial comparing open surgical tracheostomy with endoscopically guided percutaneous dilational tracheotomy. Laryngoscope 111:494–500PubMedCrossRefGoogle Scholar
  24. 24.
    Freeman BD, Isabella K, Cobb JP et al (2001) A prospective, randomized study comparing percutaneous with surgical tracheostomy in critically ill patients. Crit Care Med 29:926–930PubMedCrossRefGoogle Scholar
  25. 25.
    Cobean R, Beals M, Moss C et al (1996) Percutaneous dilatational tracheostomy. A safe, cost-effective bedside procedure. Arch Surg 131:265–271PubMedCrossRefGoogle Scholar
  26. 26.
    Delaney A, Bagshaw SM, Nalos M (2006) Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis. Crit Care 10:R55PubMedCrossRefGoogle Scholar
  27. 27.
    Freeman BD, Isabella K, Lin N et al (2000) A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest 118:1412–1418PubMedCrossRefGoogle Scholar
  28. 28.
    Oliver ER, Gist A, Gillespie MB (2007) Percutaneous versus surgical tracheotomy: an updated meta-analysis. Laryngoscope 117:1570–1575PubMedCrossRefGoogle Scholar
  29. 29.
    Antonelli M, Michetti V, Di Palma A et al (2005) Percutaneous translaryngeal versus surgical tracheostomy: a randomized trial with 1-yr double-blind follow-up. Crit Care Med 33:1015–1020PubMedCrossRefGoogle Scholar
  30. 30.
    Melloni G, Muttini S, Gallioli G et al (2002) Surgical tracheostomy versus percutaneous dilatational tracheostomy. A prospective-randomized study with long-term follow-up. J Cardiovasc Surg (Torino) 43:113–121Google Scholar
  31. 31.
    Friedman Y, Fildes J, Mizock B et al (1996) Comparison of percutaneous and surgical tracheostomies. Chest 110:480–485PubMedCrossRefGoogle Scholar
  32. 32.
    Hazard P, Jones C, Benitone J (1991) Comparative clinical trial of standard operative tracheostomy with percutaneous tracheostomy. Crit Care Med 19:1018–1024PubMedCrossRefGoogle Scholar
  33. 33.
    Petros S, Engelmann L (1997) Percutaneous dilatational tracheostomy in a medical ICU. Intensive Care Med 23:630–634PubMedCrossRefGoogle Scholar
  34. 34.
    Pothmann W, Tonner PH, am Esch JS (1997) Percutaneous dilatational tracheostomy: risks and benefits. Intensive Care Med 23:610–612PubMedCrossRefGoogle Scholar
  35. 35.
    Melker RJ, Gallagher TJ (1992) Transport of the critically ill/injured patient. In: Civetta JM, Taylor RW, Kirby RR (eds) Critical care, 2nd edn. JB Lippincott, Philadelphia, pp 1797–1808Google Scholar
  36. 36.
    Fernandez L, Norwood S, Roettger R et al (1996) Bedside percutaneous tracheostomy with bronchoscopic guidance in critically ill patients. Arch Surg 131:129–132PubMedCrossRefGoogle Scholar
  37. 37.
    Cosgrove JE, Sweenie A, Raftery G et al (2006) Locally developed guidelines reduce immediate complications from percutaneous dilatational tracheostomy using the Ciaglia Blue Rhino technique: a report on 200 procedures. Anaesth Intensive Care 34:782–786PubMedGoogle Scholar
  38. 38.
    Johnson JL, Cheatham ML, Sagraves SG et al (2001) Percutaneous dilational tracheostomy: a comparison of single- versus multiple-dilator techniques. Crit Care Med 29:1251–1254PubMedCrossRefGoogle Scholar
  39. 39.
    Byhahn C, Wilke HJ, Halbig S et al (2000) Percutaneous tracheostomy: Ciaglia Blue Rhino versus the basic Ciaglia technique of percutaneous dilational tracheostomy. Anesth Analg 91:882–886PubMedCrossRefGoogle Scholar
  40. 40.
    Petros S (1999) Percutaneous tracheostomy. Crit Care 3:R5–R10PubMedCrossRefGoogle Scholar
  41. 41.
    Griggs WM, Myburgh JA, Worthley LI (1991) A prospective comparison of a percutaneous tracheostomy technique with standard surgical tracheostomy. Intensive Care Med 17:261–263PubMedCrossRefGoogle Scholar
  42. 42.
    Westphal K, Maeser D, Scheifler G et al (2003) PercuTwist: a new single-dilator technique for percutaneous tracheostomy. Anesth Analg 96:229–232PubMedGoogle Scholar
  43. 43.
    Birbicer H, Doruk N, Yapici D et al (2008) Percutaneous tracheostomy: a comparison of PercuTwist and multi-dilatators techniques. Ann Card Anaesth 11:131PubMedCrossRefGoogle Scholar
  44. 44.
    Higgins D, Bunker N, Kinnear J (2009) Follow-up of patients with tracheal ring fractures secondary to antegrade percutaneous dilational tracheostomy. Eur J Anaesthesiol 26:147–149PubMedCrossRefGoogle Scholar
  45. 45.
    Montcriol A, Bordes J, Asencio Y et al (2011) Bedside percutaneous tracheostomy: a prospective randomised comparison of PercuTwist versus Griggs’ forceps dilational tracheostomy. Anaesth Intensive Care 39:209–216PubMedGoogle Scholar
  46. 46.
    Anon JM, Escuela MP, Gomez V et al (2004) Percutaneous tracheostomy: Ciaglia Blue Rhino versus Griggs’ guide wire dilating forceps. A prospective randomized trial. Acta Anaesthesiol Scand 48:451–456PubMedCrossRefGoogle Scholar
  47. 47.
    Ambesh SP, Pandey CK, Srivastava S et al (2002) Percutaneous tracheostomy with single dilatation technique: a prospective, randomized comparison of Ciaglia Blue Rhino versus Griggs’ guidewire dilating forceps. Anesth Analg 95:1739–1745PubMedCrossRefGoogle Scholar
  48. 48.
    Fikkers BG, Staatsen M, van den Hoogen FJ et al (2011) Early and late outcome after single step dilatational tracheostomy versus the guide wire dilating forceps technique: a prospective randomized clinical trial. Intensive Care Med 37:1103–1109PubMedCrossRefGoogle Scholar
  49. 49.
    Byhahn C, Westphal K, Meininger D et al (2002) Single-dilator percutaneous tracheostomy: a comparison of PercuTwist and Ciaglia Blue Rhino techniques. Intensive Care Med 28:1262–1266PubMedCrossRefGoogle Scholar
  50. 50.
    Zgoda MA, Berger R (2005) Balloon-facilitated percutaneous dilational tracheostomy tube placement: preliminary report of a novel technique. Chest 128:3688–3690PubMedCrossRefGoogle Scholar
  51. 51.
    Gromann TW, Birkelbach O, Hetzer R (2009) Balloon dilatational tracheostomy: initial experience with the Ciaglia Blue Dolphin method. Anesth Analg 108:1862–1866PubMedCrossRefGoogle Scholar
  52. 52.
    Sarani B, Kinkle W, Reilly P (2008) Pitfalls in percutaneous dilational tracheostomy using the Ciaglia one-step technique. South Med J 101:297–302PubMedCrossRefGoogle Scholar
  53. 53.
    Cianchi G, Zagli G, Bonizzoli M et al (2010) Comparison between single-step and balloon dilatational tracheostomy in intensive care unit: a single-centre, randomized controlled study. Br J Anaesth 104:728–732PubMedCrossRefGoogle Scholar
  54. 54.
    Rezende-Neto JB, Oliveira AJ, Neto MP et al (2011) A technical modification for percutaneous tracheostomy: prospective case series study on one hundred patients. World J Emerg Surg 6:35PubMedCrossRefGoogle Scholar
  55. 55.
    Nates JL, Cooper DJ, Myles PS et al (2000) Percutaneous tracheostomy in critically ill patients: a prospective, randomized comparison of two techniques. Crit Care Med 28:3734–3739PubMedCrossRefGoogle Scholar
  56. 56.
    Yurtseven N, Aydemir B, Karaca P et al (2007) PercuTwist: a new alternative to Griggs’ and Ciaglia’s techniques. Eur J Anaesthesiol 24:492–497PubMedCrossRefGoogle Scholar
  57. 57.
    Cantais E, Kaiser E, Le-Goff Y et al (2002) Percutaneous tracheostomy: prospective comparison of the translaryngeal technique versus the forceps-dilational technique in 100 critically ill adults. Crit Care Med 30:815–819PubMedCrossRefGoogle Scholar
  58. 58.
    Divisi D, Altamura G, Di Tommaso S et al (2009) Fantoni translaryngeal tracheostomy versus Ciaglia Blue Rhino percutaneous tracheostomy: a retrospective comparison. Surg Today 39:387–392PubMedCrossRefGoogle Scholar
  59. 59.
    Kaiser E, Cantais E, Goutorbe P et al (2006) Prospective randomized comparison of progressive dilational vs forceps dilational percutaneous tracheostomy. Anaesth Intensive Care 34:51–54PubMedGoogle Scholar
  60. 60.
    Van Heurn LW, Mastboom WB, Scheeren CI et al (2001) Comparative clinical trial of progressive dilatational and forceps dilatational tracheostomy. Intensive Care Med 27:292–295PubMedCrossRefGoogle Scholar
  61. 61.
    Stocchetti N, Parma A, Lamperti M et al (2000) Neurophysiological consequences of three tracheostomy techniques: a randomized study in neurosurgical patients. J Neurosurg Anesthesiol 12:307–313PubMedCrossRefGoogle Scholar
  62. 62.
    Remacle M, Lawson G, Jamart J et al (2008) Comparison between the Percutwist and the Ciaglia percutaneous tracheotomy techniques. Eur Arch Otorhinolaryngol 265:1515–1519PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Jonathan Cools-Lartigue
    • 1
  • Ali Aboalsaud
    • 1
  • Heather Gill
    • 1
  • Lorenzo Ferri
    • 1
  1. 1.LD MacLean Surgical Research Laboratories, Department of Surgery, Montreal General HospitalMcGill UniversityMontrealCanada

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