Percutaneous tracheostomy: Ciaglia Blue Rhino versus Griggs' Guide Wire Dilating Forceps. A prospective randomized trial

Background: Percutaneous tracheostomy (PT) has gained widespread acceptance to control the airway in patients requiring prolonged mechanical ventilation. Since 1985, new techniques for PT have been described. It was the aim of this investigation to compare two different PT techniques: the Ciaglia Blue Rhino (CBR) and the Guide Wire Dilating Forceps (GWDF). Methods: A prospective randomized trial was performed in four intensive care units. After informed consent, 53 consecutive patients were randomized to undergo CBR or GWDF. Procedural complications were evaluated and specific symptoms of the upper airway tract in survivors were assessed. Results: Twenty-seven patients were randomly assigned to CBR and 26 to GWDF. Patients mean ages were 62.7 ± 15.8 years and 62.2 ± 18.3, respectively. Mean APACHE II scores were 20.6 ± 6.8 and 21.2 ± 7.2, respectively. Median duration of the procedure was 7 min (range: 4-17 min) with GWDF and 9 min (range: 5-32 min) with CBR (P = 0.16). Seven patients in the group undergoing GWDF had complications (desaturation: two; mild bleeding: one; infected stoma: one; inability to complete the procedure: three). Two patients had complications in the group undergoing CBR (mild bleeding) (P = 0.07). Survivors were followed up after discharge. Three patients (all of them having undergone GWDF) were symptomatic (two with mild hoarseness and one with a persistent foreign body sensation), but laryngotracheoscopy was negative. Conclusions: Our results show no differences between both techniques regarding surgical duration or procedural complications. Late symptoms were encountered in three patients undergoing GWDF, however, laryngotracheoscopy failed to document anatomical or functional abnormalities.