Percutaneous tracheostomy and cricothyrotomy techniques

Percutaneous tracheostomy is currently accepted as a standard technique for longer-term airway care in the critically ill patients in many intensive care units (ICUs). Early tracheostomy has not shown any survival benefit compared to late tracheostomy following prolonged tracheal intubation in ICU patients. The main indications for tracheostomy in the ICU setting include weaning from artificial ventilation or airway protection. Nevertheless, many questions about choice of techniques, post-tracheostomy care and decannulation remain unanswered. This review gives an overview of current techniques.     

Percutaneous tracheostomy and cricothyrotomy: applied anatomy and techniques

Percutaneous tracheostomy is currently accepted as the standard technique for longer-term airway care in the critically ill patient in many ICUs. Nevertheless, many questions about timing, indications, choice of techniques, and decannulation remain. This review gives an overview of applied anatomy and techniques.     

A laboratory comparison of two techniques of emergency percutaneous tracheostomy

This laboratory study was designed to compare the speed of placement of a percutaneous tracheostomy using two common methods and to evaluate any damage caused to the trachea. The same operator who was experienced with both techniques placed 10 percutaneous tracheostomies into a pig tracheal model, five using the Griggs tracheostomy forceps technique and five using the Ciaglia sequential dilatation technique. Placement of the tracheostomy was significantly faster using the Griggs technique (mean 89 s, range 69–105 s) than using the Ciaglia sequential dilator technique (mean 217 s, range 180–267 s). Damage to the posterior wall was noted in four of the tracheas. We concluded that the Griggs technique is rapid and in trained hands may be suitable for emergency airway access. In addition, the pig trachea model is easy to set up and provides a very useful training tool.     

Tracheotomy and inhalation injury

Indications for tracheotomy in patients with respiratory burns have been unclear. Much of the literature is inconclusive or misleading. A thorough understanding of the pathogenesis, diagnosis, and therapy of inhalation injury is necessary to understand the role of tracheotomy. A critical review reveals relatively clearcut indications for the use of tracheotomy in inhalation injury, but many unanswered questions. Increased participation by otolaryngologists in burn management is recommended.