Percutaneous dilatational tracheostomy: a revolutionary technique
Unconventional Medicine
Percutaneous dilatational tracheostomy (PDT) is the gold standard for patients hospitalized in intensive care who require long periods of mechanical ventilation. Several PDT techniques proposed over the years are based on the original Ciaglia description (1-3).
An innovative technique of PDT, the Ciaglia Blue Dolphin ™, has been available for several months. It combines the expansive action of a balloon and the insertion of the tracheostomy tube in one step (4).
The use of the traditional kit had shown some intraoperative complication (fracture of tracheal rings or lesions of the posterior wall of the trachea) (5.6).
The particularity of this device has to do with the dilatational action produced by forces that move in a plane parallel to the trachea and are directed radially at 360 °, starting from the balloon introduced around the guide wire. These forces do not exert pressure perpendicular to the trachea and therefore there is no risk that the dilator, when advanced, can damage the back wall.
In other methods, once the stoma is created, the dilator is removed to allow the introduction of the cannula. In this brief interval (remove the dilator-introduce the cannula) the dilated tissues tend to close down, even if slightly, due to hysteresis. This may create difficulties for the placement of the cannula at the first attempt, and subsequent attempts can separate the tissue planes and create false pathways, or cause the later development of subcutaneous emphysema.
With the Blue Dolphin the tracheostomy tube is assembled around the dilator and therefore there is no time interval between removal of the introducer and the introduction of the cannula: everything takes place in one step.
In our initial observational study we found that the nylon balloon exerted the radial expansion well and quickly, creating a round and precise opening, allowing the simultaneous introduction of the cannula.
We compared the performance of the Blue Dolphin and PercuTwist (Table 1).
Blue Dolphin
10 patients PercuTwist
40 patients
Learning curve Short Medium
Tracheostomy cannula in false lumen 0 2.5
Intraoperative bleeding 0 0
Dilatational difficulties 0 2.50%
Tracheal ring fractures 0 2.50%
Cannula introduction difficulties 0 7.50%
Time required for the procedure 9 minutes 12 minutes
Subcutaneous emphysema 0 5.00%
Table I – Blue Dolphin and PercuTwist performance
Due to its simplicity, ease, freedom from intraoperative complications, absence of infections and post-decannulation stenosis, as well as reasonable cost, the Blue Dolphin technique is the procedure of choice for the routine performance of bedside percutaneous tracheostomy.
Bibliography
1. Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy: a new simple bedside procedure; preliminary report. Chest 1985, 87:715-719.
2. Neema PK, Manikandan S. Tracheostomy and its variants. Indian J. Anaesth 2005, 49 (4) :232-327
3. De Nicola A, Sucre MJ et al. Early tracheotomy improve the outcome PercuTwist from posttraumatic acute respiratory distress syndrome. A homes the report. 14 th World Congress of Anaesthesiologits 2008 Cape Town.
4. Byhahn C et al. Ciaglia Blue Dolphin: a new technique for percutaneous tracheostomy using balloon dilation. Critical Care 2008, 12 (Suppl 2): P333
5. De Nicola A, Sucre MJ et al. A prospective evaluation of routine use of PercuTwist controlled rotating dilation. 14 th World Congress MJ, De Nicola et al. Early PercuTwist: 3 years experience. Vol 74, Suppl. At No. 2 10 Minerva Anestesiologica October 2008. of 2008 Cape Town Anaesthesiologits
6. SucreM.J, De Nicola A. et al.. Early PercuTwist: a 3 year experience. Vol. 74, Suppl.2 al N. 10 Minerva Anestesiologica Ottobre 2008.
De Nicola Aniello, Sucre Maria José
Complex Structure of Anesthesiology and Intensive Care - Hospital San Leonardo - Castellammare di Stabia - ASL NA 3.
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Percutaneous dilatational tracheostomy (PDT) is the gold standard for patients hospitalized in intensive care who require long periods of mechanical ventilation. Several PDT techniques proposed over the years are based on the original Ciaglia description (1-3).
An innovative technique of PDT, the Ciaglia Blue Dolphin ™, has been available for several months. It combines the expansive action...read
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Percutaneous dilatational tracheostomy (PDT) is the gold standard for patients hospitalized in intensive care who require long periods of mechanical ventilation. Several PDT techniques proposed over the years are based on the original Ciaglia description (1-3). 
This is an excerpt from my log book of my mission at the Tiziano Terzani hospital,
Emergency, Lashkar Gah, Afghanistan (December 2007 - June 2008).
Sunday, January 27, 2008
"..... But what does it mean to be a member of Emergency? And who in hell knows ... only one month to reply...
But that's why you write, to write down in the memory emotions, events, objectives, and take a snapshot...
If we ask what is meant by the term all communication, we find that overall there is a common understanding of its meaning, at the most confused with information, but if we ask what ethic means, particularly when applied to the field of healthcare, there is greater difficulty in finding a common definition. Most people would relate it with the testing of drugs, others to various ethics, penal, or...
Nearly 12 million Italians are likely to spend a “sleepless” night with consequent impact on quality of life and physical and psycho-physiological functions.
Insomnia is nothing but an experience of inadequate or poor quality sleep, which can manifest as difficulty of falling asleep or staying asleep, and can be occasional or chronic, if it lasts more than a month.
It is important that...
The loss of ovarian activity and of production of estrogen during menopause is responsible for different clinical manifestations, some immediate, others long term, causing not only the appearance of the typical climacteric symptoms, such as hot flushes, night sweats, changes in mood, vaginal atrophy and dyspareunia, but also a modification of glyco-insulin, lipid and bone metabolism, and an...
