The most widely used technique in the ICU
Percutaneous dilation tracheostomy (PDT) has become routine in intensive care units around the world,1, 2 with the Ciaglia technique recognized as the most widely used method.3 The Tracoe Experc Dialation Set is based on this proven, popular technique. The Experc Set includes all necessary components to create a tracheostoma at the bedside without the need to move a critically ill patient – reducing potential risk of patient deterioration.
Endotracheal tube vs. tracheostomy tube
Tracheotomy is a lifesaving procedure that secures the airway of a patient in the event of blockage or other complications. Compared to an endotracheal tube, ventilation via a tracheostomy tube prevents long-term intubation damage in the laryngeal region.6
Ciaglia technique
The Tracoe Experc Dilation Set uses the Ciaglia method of percutaneous dilation tracheostomy, which is the most widely used tracheostomy technique in the ICU.4, 5
Surgical tracheotomy (ST) and its downsides
ST is a resource-consuming procedure performed in an operating room by designated ENT surgeons and their team.7 This can incur high costs due to required equipment, staff and the use of an operating room. Due to the higher resource requirement for ST, there can be delays in timing.8 The need to transport the patient can also increase the procedure time.
There are also differences in terms of closure after decannulation. While spontaneous closure often occurs with the dilated stoma, surgically-created tracheostoma often require further surgical intervention to close the stoma.9, 10
A surgical tracheostomy might result in a more permanent and prominent scar, affecting the cosmetic outcome negatively in the long-term determining that PDT might be superior regarding aesthetic outcomes. 11, 12, 13
PDT vs. surgical
The literature describes PDT as a less invasive procedure when compared to surgical tracheostomy. PDTs use of a single puncture and dilation results in a small incision with less traumatic injury to surrounding tissue and a tracheostomy tube that fits securely within its stoma. 9, 10, 14
A significant decrease of late complications in PDT such as tracheal stenosis or malacia, delayed wound healing, fistulas or cosmetic discrepancies were also observed. 3, 14, 15
- the procedure time is significantly shorter for PDT than surgical
- can be performed bedside on ICU without the need of patient transfer 3
- is found to be as safe as ST in the icu setting 3, 16
- is associated with a low complication rate compared to ST 15, 16
- with regard to the factors mentioned the PDT is more cost-effective than ST 3, 15
Learn more about our Tracoe Experc products
This product walkthrough shows all of the elements included with the Tracoe Experc Dilation Set for percutaneous dilation tracheostomy based on the Ciaglia technique, as well as the 14 different Tracoe tube types. The primary tubes are available pre-mounted on their respective insertion systems for a minimally traumatic tube placement.
Tracoe Experc products
Percutaneous dilation tracheostomy (PDT) has become a routine procedure in intensive care units.1, 2 The Ciaglia technique is now the most widely used method.3 The Tracoe Experc system is based on this proven technique. The products are tailored to the use of fenestrated and non-fenestrated tracheostomy tubes, including tubes with subglottic suction. They are supplied already mounted on their minimally traumatic insertion systems (P-tubes).
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1 Cabrini L, Landoni G, Greco M, Costagliola R, Monti G, Colombo S, Greco T, Pasin L, Borghi G, Zangrillo A (2014). Single dilator vs. guide wire dilating forceps tracheostomy: a meta-analysis of randomized trials. Acta Anaesthesiol Scand, 58(2):135-42.
2 Sanabria A (2014). Which percutaneous tracheostomy method is better? A systematic review. Respir Care,59(11):1660-70.
3 Rana S, Pendem S, Pogodzinski MS, Hubmayr RD, Gajic O (2005). Tracheostomy in critically ill patients. Mayo Clin Proc, 80(12):1632-8.Z
4 Sanabria A (2014). Which percutaneous tracheostomy method is better? A systematic review. Respir Care,59(11):1660-70.
5 Delaney, A., Bagshaw, S. M., & Nalos, M. (2006). Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis. Critical care, 10(2), 1-13.
6 Fichtner, F., Mörer, O., Laudi, S., Weber-Carstens, S., & Kaisers, U. (2017). S3-Leitlinie „Invasive Beatmung und Einsatz extrakorporaler Verfahren bei akuter respiratorischer Insuffizienz “. DIVI, 4, 154-163.
7 Klotz, R., Klaiber, U., Grummich, K., Probst, P., Diener, M.K., Büchler, M.W. and Knebel, P. (2015). Percutaneous versus surgical strategy for tracheostomy: protocol for a systematic review and meta-analysis of perioperative and postoperative complications. Systematic Reviews, [online] 4(1).
8 Bowen CP, Whitney LR, Truwit JD, Durbin CG, Moore MM. (2001). Comparison of safety and cost of percutaneous versus surgical tracheostomy. Am Surg. Jan;67(1):54-60. PMID: 11206898
9 Decker, S., Gottlieb, J., Cruz, D. L., Müller, C. W., Wilhelmi, M., & Krettek, C. (2016). Percutaneous dilatational tracheostomy (PDT) in trauma patients: a safe procedure. European Journal of Trauma and Emergency Surgery, 42(5), 605-610.
10 Nasa P, Singh A, Juneja D, Garg N, Singh O, Javeri Y (2012). Emergency percutaneous tracheostomy in two cancer patients with difficult airway: An alternative to cricothyroidotomy? South Asian J Cancer, 1(2): 90-92.
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