title: Locally developed guidelines reduce immediate complications from percutaneous dilatational tracheostomy using the Ciaglia Blue Rhino technique: a report on 200 procedures.
abstract: Ciaglia Blue Rhino percutaneous dilatational tracheostomy is used as an aid to ventilatory weaning. It carries an immediate complication rate previously reported in 100 consecutive patients by Fikkers et al at 6% for "major" complications and 30% for "minor" complications. Mortality has been associated with the procedure. Our institution has performed dilatational percutaneous tracheostomy since 1998 and used the Blue Rhino technique since 2002. Consensus guidelines were developed following initial experiences. They focus on preoperative risk assessment including levels of ventilatory support and anatomical considerations, seniority of staff use of bronchoscopy and capnography and correction of coagulopathies. Following introduction of the guidelines we conducted an audit of the first 200 Ciaglia Blue Rhino tracheostomies performed. There was an immediate major complication rate of 3% and minor complication rate of 18%. No deaths occurred within 24 hours of the procedure. We conclude that applying our consensus guidelines produced an immediate complication rate for Ciaglia Blue Rhino percutaneous dilatational tracheostomy below published audits.
authors.affiliation: Department of Perioperative and Critical Care, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
authors.forename: J E
authors.initials: JE
authors.lastname: Cosgrove
authors.forename: A
authors.initials: A
authors.lastname: Sweenie
authors.forename: G
authors.initials: G
authors.lastname: Raftery
authors.forename: S M
authors.initials: SM
authors.lastname: Carey
authors.forename: A J
authors.initials: AJ
authors.lastname: Kilner
authors.forename: I D
authors.initials: ID
authors.lastname: Nesbitt
authors.forename: D M
authors.initials: DM
authors.lastname: Cressey
authors.forename: N
authors.initials: N
authors.lastname: Hirschauer
authors.forename: P G
authors.initials: PG
authors.lastname: Laws
authors.forename: D W
authors.initials: DW
authors.lastname: Ryan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D032921:Consensus; D004106:Dilatation / Q000009:adverse effects* / Q000379:methods; D004867:Equipment Design; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D008485:Medical Audit / Q000379:methods; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D014139:Tracheostomy / Q000009:adverse effects* / Q000379:methods / Q000592:standards; D015300:Ventilator Weaning / Q000295:instrumentation / Q000379:methods