[Percutaneous tracheostomy through dilatation with the Ciaglia Blue Dolphin(®) method]. / Traqueotomía percutánea por dilatación con el método Ciaglia Blue Dolphin(®)

ABSTRACT

OBJECTIVE: To describe the perioperative and postoperative complications in critically ill patients requiring percutaneous tracheostomy using the Ciaglia Blue Dolphin(®) technique. DESIGN: A prospective, observational, cohort study was carried out. SCOPE Two medical-surgical Intensive Care Units. PATIENTS Adult patients subjected to prolonged mechanical ventilation. INTERVENTION Percutaneous tracheostomy using Ciaglia Blue Dolphin(®) with an endoscopic guide. VARIABLES Demographic variables, intraoperative and postoperative complications, and Intensive Care Unit and ward mortality were recorded. RESULTS: Seventy patients were included. Age 68.6 ± 12 years (68.6% males). APACHE II score 23.5±8.7. Duration of mechanical ventilation prior to percutaneous tracheostomy 14.3 ± 5.5 days. Perioperative complications were recorded in 25 patients. In 23 of them the complications were mild difficulty inserting the tracheostomy cannula (n=10), mild bleeding (n=7), partial atelectasis (n=3), cuff leak (n=2), and technical inability to complete the procedure (switch to Ciaglia Blue Rhino(®)) (n=1). Severe complications were recorded in 2 patients severe bleeding that forced completion of the procedure via surgical tracheostomy (n=1), and false passage with desaturation (n=1). None of the complications proved life-threatening. Eleven complications occurred in the learning curve. As postoperative complications, mild peri-cannula bleeding was seen in 2 patients. CONCLUSIONS: Percutaneous tracheostomy using the Ciaglia Blue Dolphin(®) technique with an endoscopic guide is a safe procedure. As with other procedures, the learning curve contributes to increase the incidence of complications. Potential benefits versus other percutaneous tracheostomy techniques should be explored by randomized trials.