Comparative Clinical Trial between Ciaglia and Griggs Techniques during Tracheostomy Performed in Patients Admitted to Intensive Care Unit
Percutaneous dilatation tracheostomy (PDT) is one of the most frequent interventions in ventilator dependant ICU patients. Ciaglia and Griggs are two common PDT techniques. Few studies are available comparing these two methods, but there is no data available to compare these two techniques in Iranian population. The aim of this study was to compare Ciaglia and Griggs technique in our population in order to recognize advantages and disadvantages of each technique in order to identify the most beneficial one. This study is a comparative clinical trial conducted on 100 consecutive ICU admitted patients who needed prolonged intubation; half of them underwent PDT with Ciaglia method and other half with Griggs method. Procedural time and short term complications including bleeding, vital signs instability and technical errors were compared in both two methods. Both groups were comparable in demographic characteristics. Griggs method performed significantly faster than Ciaglia method (P=0.001). Complications such as high grade bleeding (P=0.01) and cardiac dysrhythmias (P=0.07) were less in Ciaglia technique than Griggs. Skin incision smaller than required was reported more with Griggs method than Ciaglia (P=0.03). We conclude that PDT with Ciaglia method is safer with less complications than the Griggs method. We suggest use of Ciaglia for less experienced operators.
Margulies DR, Mischael S. Percutaneous dilational tracheostomy. In: Fink MP, Abraham E, Kochanek PM, Vincent JL, editors. Textbook of Critical Care. 5th ed. Philadelphia, PA: Elsevier Saunders; 2005. p. 1871-75.
Ambesh SP, Pandey CK, Srivastava S, Agarwal A, Singh DK. Percutaneous tracheostomy with single dilatation technique: a prospective, randomized comparison of Ciaglia blue rhino versus Griggs' guidewire dilating forceps. Anesth Analg 2002;95(6):1739-45.
Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report. Chest 1985;87(6):715-9.
Charra B, Hachimi A, Benslama A, Motaouakkil S. Tracheotomy versus prolonged intubation in medicalintensive care unit patients. Signa Vitae 2009;4(1):21-3.
Hazard P, Jones C, Benitone J. Comparative clinical trial of standard operative tracheostomy with percutaneoustracheostomy. Crit Care Med 1991;19(8):1018-24.
Friedman Y, Franklin C. The technique of percutaneoustracheostomy. Using serial dilation to secure an airway with minimal risk. J Crit Illn 1993;8(2):289-97.
Anon JM, Gomez V, Escuela MP, Paz VD, Solana LF, De La Casta RM, Perez JC, Zeballos E, Navarro L. Percutaneous tracheostomy: comparison of Ciaglia and Griggs techniques. Crit Care 2000;4(2):124-8.
Van Heurn LW, Mastboom WB, Scheeren CI, Brink PR, Ramsay G. Comparative clinical trial of progressive dilatational and forceps dilatational tracheostomy.Intensive Care Med 2001;27(1):292-5.
Kaiser E, Cantais E, Goutorbe P, Salinier L, Palmier B. Prospective randomized comparison of progressive dilational vs forceps dilational percutaneous tracheostomy. Anaesth Intensive Care 2006;34(1):51-4.
Moe KS, Stoeckli SJ, Schmid S, Weymuller EA Jr. Percutaneous tracheostomy: a comprehensive evaluation. Ann Otol Rhinol Laryngol 1999;108(4):384-91.
Marelli D, Paul A, Manolidis S, Walsh G, Odim JN, Burdon TA, Shennib H, Vestweber KH, Fleiszer DM, Mulder DS. Endoscopic guided percutaneous tracheostomy: early results of a consecutive trial. J Trauma 1990;30(4):433-5.
Manara AR. Experience with percutaneous tracheostomy in intensive care: the technique of choice? Br J Oral Maxillofac Surg 1994;32(3):155-60.
Winkler WB, Karnik R, Seelmann O, Havlicek J, Slany J.Bedside percutaneous dilational tracheostomy with endoscopic guidance: experience with 71 ICU patients.Intensive Care Med 1994;20(7):476-9.
Moore FA, Haenel JB, Moore EE, Read RA. Percutaneous tracheostomy/gastrostomy in brain-injured patients: a minimally invasive alternative. J Trauma 1992;33(3):435-9.
Kornblith LZ, Burlew CC, Moore EE, Haenel JB, Kashuk JL, Biffl WL, Barnett CC, Johnson JL. One thousand bedside percutaneous tracheostomies in the surgical intensive care unit: time to change the gold standard. J Am Coll Surg 2011;212(2):163-70.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.