Article
Percutaneous dilatational tracheostomy in the neurosurgical intensive care unit: First clinical experiences with the Ciaglia Blue Dolphin technique
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Authors
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Andrea Finis
- Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Germany
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Volker Martin Tronnier
- Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Germany
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Jan Gliemroth
- Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Germany
| Published: | September 16, 2010 |
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Outline
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Objective: Tracheostomy continues to be a standard procedure in the management of patients receiving long-term mechanical ventilation to prevent the complications associated with prolonged translaryngeal intubation. The minimally invasive percutaneous dilatational tracheostomy (PDT) is an alternative method to the conventional operative tracheostomy, which can be performed at the bedside in the ICU. In experienced hands, it is a minimally invasive and safe technique. In 1985 Ciaglia introduced a new method of serial dilatation over a Seldinger guidewire using tapering dilators. In 1999 the technical equipment was sophisticated with the introduction of the Ciaglia Blue Rhino that consists of one-step dilation by means of a curved dilator with hydrophilic coating. In 2008 these technique was further improved by introduction of Ciaglia Blue Dolphin using a balloon dilation technique. Our first experience with the new technique on the neurosurgical ICU was described.
Methods: Thirty patients of a neurosurgical intensive care unit suffering of a critical primary disease (TBI, ICH, SAH) who would have a long-term mechanical ventilation underwent PDT with the Ciaglia Blue Dolphin system. Time of surgery, perioperative complications and handling of using the new system in these patients were compared with a retrospective group of 200 patients who had underwent PDT by using the Ciaglia Blue Rhino system.
Results: Surgery lasted between 3.15 min and 13.3 min by using the Blue Dolphin system. By using the Blue Rhino system PDT lasted between 1.03 min and 15.05 min. In case of 5 patients a change of Ciaglia Blue Dolphin to Ciaglia Blue Rhino had to be done because of technical problems in balloon dilatation or a changing was due to an impossible placement of a tracheal cannula. Complication rates were almost of the same amount and reason.
Conclusions: The Blue Dolphin system should be of advantage by decrease bleedings through tissue compression, but the period of balloon dilatation prolongs the time of surgery. The handling is more complicated and demands a learning curve. However, PDT is in the hands of experts an effective technique and rare of complications. Therefore it is a useful therapy for critically ill patients.
