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Most PDTs used a multiple dilator technique and were performed in the intensive care unit (ICU).
The majority (71%) of PDTs used a multiple dilator technique and 94% were performed in the ICU.
As the majority of studies included in this review used the multiple dilator technique, it is not surprising the results failed to demonstrate any particular benefit from one specific technique of PDT.
The other study, that by Berrouschot and coworkers [ 3], in which the multiple dilator technique was employed, reported a 7.9% major perioperative complication rate, including one death (caused by tracheal laceration).
We analyzed the available literature published up until 2002 and found that major complications varied from 0%to14%4% (average 3.0%) in 28 studies (4066 patients) that used the multiple dilator technique; from 0%to4.9%9% (average 3.0%) in six studies (461 patients) that used the GWDF technique; and from 1.3% to 5.0% (average 2.8%) in three studies (286 patients) using the CBR technique.
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Several randomized studies have compared the six techniques of percutaneous tracheotomy: multiple dilator, guide wire dilating forceps, single dilator, rotating dilation, balloon dilation, and translaryngeal tracheotomy.
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.
Ciaglia technique was performed using the Ciaglia multiple dilator kit (Ciaglia Percutaneous Tracheostomy Introducer Set; William Cook Europe, Bjaeverskov, Denmark).
All of these meta-analyses included only multiple dilator tracheostomy (MDT) [ 9], guide wire dilating forceps (GWDF) [ 10], and translaryngeal tracheostomy (TLT) [ 11] in the PT group.
The single dilator technique is associated with a lower failure rate than rotating dilation [56] and a lower rate of minor complications than balloon dilation or dilation with guide wire dilating forceps [57 59].
Percutaneous tracheostomy: A 6 yr prospective evaluation of the single tapered dilator technique.
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multiple access technique
multiple threshold technique
multiple dilator kit
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multiple field technique
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multiple filter technique
multiple candidate technique
multiple shooting technique
multiple occlusion technique
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