Percutaneous dilational
tracheostomy (
PDT), according to Ciaglia's technique described in 1985, has become the most popular technique for percutaneous
tracheostomy and is demonstrably as safe as surgical
tracheostomy. In 1999, an extensively modified technique of
PDT was introduced, the Ciaglia Blue Rhino (CBR; Cook
Critical Care, Bloomington, IL), that consists of one-step dilation by means of a curved dilator with hydrophilic coating. To compare CBR with the basic technique of
PDT, we performed a prospective, randomized trial in 50
critically ill adults. Twenty-five of these patients had
PDT, and 25 had CBR. Average operating times were <3 min for CBR (range: 50-360 s) and <7 min for
PDT (range: 4-20 min; P<0.0001).
Tracheostomy was successfully completed in all patients. When CBR was performed, 11 minor, nonlife-threatening complications were noted: nine fractures of tracheal cartilage and two short periods of intraoperative
oxygen desaturation. During
PDT, seven complications occurred, of which three were potentially life-threatening: two
injuries to the posterior tracheal wall, one
pneumothorax, two tracheal
cartilage fractures (P< 0.05 vs CBR), one case of
bleeding, and one short episode of intraoperative
oxygen desaturation. Regardless of whether
PDT or CBR was performed, oxygenation was not significantly affected, and there was no
infection of the tracheostoma. Based on our data, we conclude that new CBR is more practicable than
PDT. No life-threatening complications occurred during CBR.
IMPLICATIONS: To assess practicability and safety of the Ciaglia Blue Rhino (Cook
Critical Care, Bloomington, IL)-an extensively modified technique of percutaneous dilatational tracheostomy-50
critically ill adults on long-term ventilation underwent either new Ciaglia Blue Rhino or percutaneous dilatational
tracheostomy in a prospective, randomized clinical trial.