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.
Ciaglia technique was performed using the Ciaglia multiple dilator kit (Ciaglia Percutaneous Tracheostomy Introducer Set; William Cook Europe, Bjaeverskov, Denmark).
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.
In contrast, when using the multiple dilator kit, the tracheal aperture is sequentially enlarged using a series of graduated dilators.
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.
Añon et al [ 6] noted a significantly lower procedure time in the Griggs guidewire dilating forceps technique compared with the Ciaglia technique employing multiple dilators.
