Forceps dilatational percutaneous tracheostomy: safe and short.
We would like to contribute to the discussion reporting our prospective, unrandomized series of percutaneous tracheostomy for long-term ventilation. Our preferred technique is the Griggs technique performed in combination with a LMA for airway control (2).
To date we have successfully performed more than 290 percutaneous tracheostomies with dilating forceps. No instances of post tracheostomy tracheal dilatation (3) have been recorded.
We agree that the Guide Wire Dilating Forceps technique is safe and easy to learn, and quicker than the consecutive/progressive dilatator technique. We believe that continuous fibreoptic monitoring is mandatory to ensure correct access and to minimize complications.
In a few cases the forceps could not be inserted to the full length due to thick subcutaneous tissue of the anterior neck. In such cases we suggest switching the percutaneous tracheostomy from forceps to progressive dilatator, allowing completion of the procedure without complications.
In our experience the removal of the endotracheal tube and substitution with a classic LMA results in a better view of the entire laryngeal inlet. The possibility of using a Pro Seal LMA instead of a classic LMA should be considered (4), especially for obese patients and those with high peak pressures.
(1.) Kaiser E, Cantais E, Goutorbe P et al. Prospective randomized comparison of progressive dilatational vs forceps dilatational percutaneous tracheostomy. Anaesth Intensive Care 2006; 34:51-54.
(2.) Cattano D, Buzzigoli S, Zoppi C et al. "The use of the Laryngeal Mask Airway during Guide wire dilatating forceps tracheostomy" IARS 80th congress, 24th-28th March San Francisco, USA Anesth Analg 2006; 102-2S:86.
(3.) Steele APH, Evans HW, Afaq MA et al. Long term follow up of Griggs tracheostomy with Spiral CT and questionnaire. Chest 2000; 117:1430-1433.
(4.) Craven RM, Laver SR, Cook TM et al. Use of the Pro Seal LMA facilitates percutaneous dilatational tracheostomy. Can J Anesth 2003; 50:718-720.
Department of Anesthesiology,
Washington University of St Louis, School of
St Louis, United States
Department of Surgery, University of Pisa,
Department of Surgery,
University of Pisa School of Medicine,
Anesthesiology and ICU Department,
Versilia Hospital, Lido di Camaiore (Lu), Italy