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CRITICAL CARE AND TRAUMA

Balloon Dilatational Tracheostomy: Initial Experience with the Ciaglia Blue Dolphin Method

From the Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.

Address correspondence and reprint requests to Tom W. Gromann, MD, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, D-13353 Berlin. Address e-mail to gromann{at}dhzb.de.

BACKGROUND: Percutaneous dilational tracheostomy has become an established technique for ensuring safe and uncomplicated access to the respiratory systems of patients undergoing prolonged intubation. We studied a new balloon dilation percutaneous dilational tracheostomy technique which primarily uses radial force to widen the tracheostoma, the Ciaglia Blue Dolphin system.

METHODS: We report our initial clinical experience with this method in 20 patients from a cardiosurgical intensive care unit. We analyzed the results with regard to the practical feasibility of balloon dilation as well as possible complications.

RESULTS: Tracheostomy surgery time averaged 3.3 ± 1.9 min. The new technique caused neither bleeding requiring treatment nor injuries of the posterior tracheal wall. Routine bronchoscopic checks revealed one fracture of a single tracheal cartilage ring (5%). One patient developed subcutaneous emphysema during the balloon dilation, but this regressed spontaneously without treatment. No wound infections or prolonged wound healing of the tracheostoma were observed in any patient. There were no differences in terms of practical feasibility or bleeding complications when skin incisions of different lengths were analyzed.

CONCLUSIONS: The balloon dilational tracheostomy proved to be a feasible, easy, and successful technique. Its use of mainly radial force may reduce typical complications such as fractures of tracheal cartilage rings or injuries of the posterior tracheal wall.