Review of Critical Care Medicine

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Percutaneous dilatational tracheostomy (PDT)

Posted by Dr KAMAL DEEP on September 12, 2011

The author wish to acknowledge the excellent guidance of Dr Harjit Singh Mahay, Sr. Intensivist ; New Delhi in this topic.

If the first two tracheal rings cannot be distinctly identified, the procedure is aborted and an open tracheostomy is performed.

Equipment required at the bedside to perform the PDT pro-cedure includes the following:
•PDT introducer set (Ciaglia Blue Rhino Percutaneous Tracheostomy Introducer Set #C-PTIS-100-HC)
•Bronchoscope with video monitor display and bron-choscopy endotracheal tube adapter
•Continuous electrocardiographic (ECG) monitor
•Blood pressure monitoring device
•Pulse oximeter
•Free-flowing intravenous catheter
•Mechanical ventilator
•Suction
•Resuscitation (“crash”) cart
•Open tracheostomy instrument tray (unopened)

Types of PCT
Ciaglia technique
Grigg’s technique
Blue rhino / Rhino horn technique
Fantony’s technique
Perc twist technique

Surgical Tracheostomy preferable to PCT in the
following situations:
Coagulation abnormality
High level of ventilatory support (FiO2 >.7 & PEEP
> 10 cm H2O)
Unstable / Fragile cervical spine
Neck injury
Unfavorable neck anatomy (previous surgery, tumor
etc.)
Obesity

PDT

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