Percutaneous tracheostomy through dilatation with the Ciaglia Blue Dolphin® method

Objective: To describe the perioperative and postoperative complications in critically ill patients requiring percutaneous tracheostomy using the Ciaglia Blue Dolphin(R) 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(R) 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(R)) (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(R) 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. (C) 2014 Elsevier Espana, S.L.U. and SEMICYUC. All rights reserved.