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Percutaneous dilatational tracheostomy (PDT) has gained widespread acceptance in many ICU and trauma centers as a viable alternative approach. Numerous investigative reports show that all traditional techniques for PDT have similar complications. The most dangerous complication is posterior tracheal wall damage during insertion of the dilational device employing downward pressure. The Ciaglia Blue Dolphin (CBD) is an innovative device for PDT using radial balloon dilation. This technique has the potential advantage of less tracheal damage over other methods by avoiding downward pressure to enter the trachea [1,2].
Case series of consecutive ICU patients with acute respiratory failure who required tracheostomy for failure to wean and continued mechanical ventilatory support. We report our clinical experience of 22 percutaneous tracheostomies performed using the CBD system (Cook, Bloomington, IN, USA). Informed consent was obtained from each patient, or family member. All procedures were performed under direct visualization using a fibreoptic bronchoscope on anaesthetised patients. The technique relies on the employ of a balloon-tipped catheter loaded over the guidewire. The balloon was inflated with saline up to 11 atmospheric pressure for 30 seconds to create a tracheostoma. A preloaded tracheostomy tube was then inserted through the stoma following balloon deflation.
Bedside PDT with the CBD system was successfully performed in the ICU for all 22 patients. Tracheostomies were performed within a mean time of 4.1 ± 1.4 minutes of the tracheal needle entry and with negligible blood loss in all patients. The procedure was not associated with a decrease in SpO2 at the time of balloon inflation. Procedural complications were limited to one patient requiring the repetition of balloon inflation for tracheostomy tube placement. There were no other immediate medical or technical problems.
The CBD has been shown to be a safe, quick and successful alternative to the traditional PDT (PercuTwist, guidewire dilating forceps, and so forth) that have a tendency to go too far and perforate the tracheal rings: the intensivist performing PDT should be aware when making the decision as to which approach to use. In our hospital, the CBD method has become the procedure of choice.