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document
Percutaneous tracheostomy in critically ill patients : a prospective , randomized comparison of two techniques . OBJECTIVE To prospectively compare two commonly used methods for percutaneous dilational tracheostomy ( PDT ) in critically ill patients . DESIGN Prospective , randomized , clinical trial . SETTING Trauma and general intensive care units of a university tertiary teaching hospital , which is also a level 1 trauma center . PATIENTS One hundred critically ill patients with an indication for PDT . INTERVENTIONS PDT with the Ciaglia technique using the Ciaglia PDT introducer set and the Griggs technique using a Griggs PDT kit and guidewire dilating forceps . MEASUREMENTS AND MAIN RESULTS Surgical time , difficulties , and surgical and anesthesia complications were measured at 0-2 hrs , 24 hrs , and 7 days postprocedure . Groups were well matched , and there were no differences between the two methods in surgical time or in anesthesia complications . Major bleeding complications were 4.4 times more frequent with the Griggs PDT kit . With the Ciaglia PDT kit , both intraoperative and at 2 and 24 hrs , surgical complications were less common ( p = .023 ) and the procedure was more often completed without expert assistance ( p = .013 ) . Tracheostomy bleeding was not associated with either anticoagulant therapy or an abnormal clotting profile . Multivariate analysis identified the predictors of PDT complications as the Griggs PDT kit ( p = .027 ) and the Acute Physiology and Chronic Health Evaluation ( APACHE ) II score ( p = .041 ) . The significant predictors of time required to complete PDT were the APACHE II score ( p = .041 ) , a less experienced operator ( p = .0001 ) , and a female patient ( p = .013 ) . CONCLUSIONS Patients experiencing PDT with the Ciaglia PDT kit had a lower surgical complication rate ( 2 % vs. 25 % ) , less operative and postoperative bleeding , and less overall technical difficulties than did patients undergoing PDT with the Griggs PDT kit . Ciaglia PDT is , therefore , the preferred technique for percutaneous tracheostomy in critically ill patients .
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Intervention_Surgical
percutaneous dilational tracheostomy ( PDT )
5011
Intervention_Surgical
PDT
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Intervention_Surgical
PDT with the Ciaglia technique using the Ciaglia PDT introducer set
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Intervention_Surgical
Griggs technique using a Griggs PDT kit
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Intervention_Surgical
guidewire dilating forceps
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Intervention_Surgical
Griggs PDT
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Intervention_Surgical
Ciaglia PDT
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Intervention_Surgical
PDT
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Intervention_Surgical
PDT
5019
Intervention_Surgical
Griggs PDT
5020
Intervention_Surgical
Ciaglia PDT
5021
Outcome_Other
Surgical time , difficulties , and surgical and anesthesia complications
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Outcome_Other
surgical time
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Outcome_Adverse-effects
anesthesia complications
5024
Outcome_Adverse-effects
Major bleeding complications
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Outcome_Adverse-effects
surgical complications
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Outcome_Physical
Tracheostomy bleeding
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Outcome_Physical
Acute Physiology and Chronic Health Evaluation ( APACHE ) II score
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Outcome_Physical
APACHE II score
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Outcome_Physical
lower surgical complication rate
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Outcome_Adverse-effects
less operative and postoperative bleeding
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Outcome_Other
overall technical difficulties
5032
Participant_Condition
percutaneous dilational tracheostomy ( PDT )
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Participant_Condition
PDT
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Participant_Condition
percutaneous tracheostomy