Percutaneous Dilatational Tracheostomy: ULTRAperc® Single Stage Dilator Technique Versus Ciaglia Blue Dolphin® Balloon Dilatation Technique for Intubated Unweanable ICU Patients

Background: Percutaneous tracheostomy is currently one of the most common procedures performed in ICU. It has demonestrated provide numerous advantages over the classical surgical tracheostomy. The aim of this study is to compare ULTRAperc single stage dilator technique with Ciaglia Blue Dolphin ballon dilatation technique for intubated unweanable ICU patients with respect to procedure difficulties and complications. Methods: A prospective randomized trial was used to compare two different techniques of percutaneous dilatational tracheostomy performed by ICU physicians in intubated unweanable ICU patients. The study included 60 intubated ICU patients with failure of liberation from mechanical ventilation, underwent bedside dilatational tracheostomy using ULTRAperc tracheostomy set (30 patients) and Ciaglia Blue Dolphin balloonset (30 patients). Both groups were compared as regards procedure technical difficulties such as difficult dilatation and difficult tube insertion and complications such as pneumothorax and subcutaneous emphysema. Results: Six patients in the Ciaglia Blue Dolphin group were difficult in dilatation and tube insertion and there was over dilatation of the tracheal stoma Compared to zero recorded cases in the ULTRAperc group (P-value = 0.024). Failed tube insertion and false passage was recorded in two cases in the Ciaglia Blue Dolphin group compared with zero recorded cases in the ULTRAperc group (P-value = 0.492). There were zero recorded cases of cardiac arrest or lung atelectasis in either groups. No significant statistical difference was found between groups as regards pneumothorax, pneumomediastinum and subcutaneous emphysema. Seven patients in the Ciaglia Blue Dolphin group experienced minor bleeding from the tracheostomy site compared with zero recorded bleeding complications in the ULTRAperc group (P-value = 0.011). Conclusions: Percutaneous dilatational tracheostomy for intubated unweanable ICU patients using ULTRAperc single stage dilator technique is easier and associated with fewer complications as compared with Ciaglia Blue Dolphin ballon dilatation technique.