Fig. 34.1
Percutaneous tracheostomy team
Fig. 34.2
Equipment needed
Fig. 34.3
Cricoid cartilage and sternal notch
Fig. 34.4
Sterile preparation
Fig. 34.5
Sterile drape
Fig. 34.6
One percent lidocaine with epinephrine injection
Fig. 34.7
Skin incision
Fig. 34.8
One and a half to two centimeter incision
Fig. 34.9
Optional blunt dissection
Fig. 34.10
Manual palpation
Fig. 34.11
Transfix trachea between index finger and thumb to prepare for central access
Fig. 34.12
Aspirate air with a fluid-filled syringe
Fig. 34.13
Advance J-wire via finder needle
Fig. 34.14
Advance punch dilator
Fig. 34.15
Advance dilating catheter
Fig. 34.16
Advance dilating catheter
Fig. 34.17
Advance tracheostomy-obturator combination
Fig. 34.18
Remove obturator-stiffening catheter-guidewire
Fig. 34.19
Bronchoscopic confirmation
Fig. 34.20
Inflate cuff attach ventilator circuit
Evidence-Based Review
Complications: Comparison with Surgical Tracheostomy
There are numerous studies that have attempted to compare the complications of the percutaneous technique to the open technique. These are best summarized by Higgins and Punthakee in a meta-analysis designed primarily to compare complication rates using randomized or quasi-randomized clinical trials only [18]. Fifteen studies met criteria for analysis with 973 as the total number of patients included (490 in the percutaneous arm and 483 in open). Wound infection and unfavorable scarring favored the percutaneous route, while the risk of decannulation/obstruction favored the open route. There was no difference noted with respect to false passage, minor or major hemorrhage, subglottic stenosis, or death. Overall complication rate “trended” toward favoring the percutaneous route, mentioned here only because the p value equaled 0.05.
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