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CRITICAL CARE AND TRAUMA

Percutaneous Tracheostomy: A Clinical Comparison of Dilatational (Ciaglia) and Translaryngeal (Fantoni) Techniques

Department of Anesthesiology, Intensive Care Medicine, and Pain Control, J. W. Goethe-University Hospital Center, Frankfurt, Germany

Address correspondence and requests for reprints to Klaus Westphal, MD, Department of Anesthesiology, J. W. Goethe-University Hospital, D-60590 Frankfurt, Germany. Address e-mail to byhahn{at}stud.uni-frankfurt.de

A number of percutaneous procedures for tracheostomy have been established within the last few years, among them a new technique by Fantoni using a translaryngeal approach for cannula placement. To compare the new translaryngeal tracheostomy (TLT) to the common percutaneous dilatational technique (PDT), we prospectively studied 90 patients who required elective tracheostomy. Tracheostomy was performed according to either the Ciaglia or the Fantoni technique in 45 patients at bedside. The overall complication rate was 11.1% (n = 5) in PDT, including aspiration of blood (n = 4) and severe bleeding requiring surgical intervention (n = 1). During TLT, there were technical difficulties involving guidewire placement in 31.1% (n = 14), and one patient required conversion to PDT. No other complications were noted in TLT. Regardless of the technique used, the postoperative PaO₂/FIO₂ ratio was slightly lower than preoperatively (P was not significant). When PDT and TLT were compared, the postoperative PaO₂/FIO₂ ratio was significantly lower in PDT than in TLT (P < 0.05), whereas the preoperative levels did not vary significantly between PDT and TLT. During TLT, the PaCO₂ increased significantly, whereas it remained stable throughout PDT. No infection of the tracheostoma was noted in either the PDT or the TLT. We therefore consider both the PDT and the TLT equally safe and attractive techniques for establishing long-term airway access in critically ill patients.

Implications: Elective tracheostomy is a widely accepted procedure for gaining long-term airway access. Two techniques for percutaneous tracheostomy—the established Ciaglia method and the new translaryngeal Fantoni technique—were prospectively studied for perioperative complications and practicability in 90 critically ill-patients.

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