[Percutaneous tracheostomy: technological development].

Abstract

PDT based on Seldinger's technique is gaining wide acceptance in ICU patients, but the procedure has undergone various modifications during the past thirty years. The ten most known procedures and the target of their innovating content are briefly examined. The incidence of complications desumed from the literature, wide in some cases and limited or absent in others, is also considered. In many cases, the technological modifications of original procedures had two fundamental objectives: to increase it's safety and to reduce the operator-depencence of the procedure. According to the review of the literature (and our experience too) the increasing interest for percutaneous tracheostomy is the justified conclusion of the technological development of some dilatative techniques. With an appropriate training and the continuous endoscopic guidance, it is possible today to perform PDT in critically ill patients of ICU with a very low total complication rate. Even if the comparison between different techniques is not rich enough on prospective randomized studies, the global low rate of hemorrhage complications, of wound infection and of poor cosmetic result are surely demonstrated and probably related to the small skin incision and the tight fitness between tissues and the tracheostomy tube.