Percutaneous tracheostomy

Background:
Percutaneous tracheostomy (PT) has gained an increasing acceptance as an alternative to the conventional surgical tracheostomy (ST). In experienced hands, and with proper patient selection, it is safe, easy and quick.

      Complications:
      Perioperative complications are comparable with those of ST and               these are mostly minor. An important advantage of PT over ST is that there is               no need to move a critically ill patient to the operating room and the rate of              stomal infection is very low. Although data on late complications of PT are not             yet sufficient, available reports show a favourable result.


      Techniques:
      Ciaglia's method is the most commonly applied, but no study               has shown superiority of any of the percutaneous techniques described. The              decision on which method to use should solely be made depending on the clinical             situation and the experience of the operator. The learning curve demands                caution, attention to detail and adequate experience on the part of the             intensive care physician. Although PT is unfortunately declared             'easy', it must be left in the hands of experienced physicians to               avoid unnecessary complications, and the risk of overimplementation should be               kept in mind.