Percutaneous tracheostomy

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.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.Tracheostomy is one of the oldest surgical procedures. The origin of percutaneous tracheostomy (PT) is not certain, although the Italian surgeon Sanctorius was probably the first to describe the technique in the 16th century. Sheldon et al. [1] used the term percutaneous tracheotomy in 1955 and described the method as an alternative to the surgical route. Toye and Weinstein [2,3] introduced the technique using the Seldinger guidewire and it has since been refined with various modifications [4,5,6,7]. The percutaneous dilatational tracheostomy (PDT) introduced by Ciaglia et al. [4] in 1985, which involves progressive dilatation with blunt-tipped dilators, is the most frequently used and evaluated in the literature [8,9,10,11,12,13,14,15,16,17,18]. In 1989, Schachner et al. [5] introduced a rapid PT technique, Rapitrac, which did not get considerable acceptance because of complications associated with, and reservations towards, the sharp edges of the dilating forceps. In 1990, Griggs et al. [6] reported on a PT technique using a modified Howard-