title: Griggs percutaneous tracheostomy without bronchoscopic guidance is a safe method: A case series of 300 patients in a tertiary care Intensive Care Unit.
abstract: BACKGROUND
  Percutaneous tracheostomy (PCT) is being increasingly done by intensivists for critical care unit patients requiring either prolonged ventilation and/or for airway protection.[1] Bronchoscopic guidance considered a gold standard,[23] is not always possible due to logistic reasons and ventilation issues. We share our experience of Griggs PCT technique without bronchoscopic guidance with simple modifications to ensure safe execution of the procedure.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the safety issues and complications of PCT without bronchoscopic guidance in a multi-disciplinary tertiary Intensive Care Unit (ICU).
  
  
  METHODS
  A retrospective review of consecutive PCTs performed in our ICU between August 2010 and December 2013 by Griggs guide wire dilating forceps technique without bronchoscopic guidance is being presented. It is done by withdrawing endotracheal tube with inflated cuff while monitoring expired tidal volume on ventilator and ensuring the free mobility of guide wire during each step of the procedure, thereby ensuring a safe placement of the tracheostomy tube (TT) in trachea.
  
  
  RESULTS
  Analysis of 300 PCTs showed 26 patients (8.6%) had complications including 2 (0.6%) patients deteriorated neurologically and 2 (0.6%) deaths observed within 24 h following procedure. The median operating time was 3.5 min (range, 2.5-8 min). There were no TT placement problems in any case.
  
  
  CONCLUSIONS
  Percutaneous tracheostomy can be safely performed without bronchoscopic guidance by adhering to simple steps as described.
authors.affiliation: Department of Critical Care Medicine, Apollo Hospitals, Bhubaneswar, Odisha, India.
authors.forename: Saroj Kumar
authors.initials: SK
authors.lastname: Pattnaik
authors.affiliation: Department of Critical Care Medicine, Apollo Hospitals, Bhubaneswar, Odisha, India.
authors.forename: Banambar
authors.initials: B
authors.lastname: Ray
authors.affiliation: Department of Critical Care Medicine, Apollo Hospitals, Bhubaneswar, Odisha, India.
authors.forename: Sharmili
authors.initials: S
authors.lastname: Sinha
keywords: Bronchoscopy; critical illness; griggs technique; percutaneous tracheostomy