[Percutaneous tracheotomy with the Ciaglia Blue Rhino technique: a critical analysis after 1 year].

OBJECTIVES: To report our experience during a learning period with the Ciaglia Blue Rhino (William Cook Europe) kit for percutaneous tracheotomy.

PATIENTS AND METHODS: This prospective, observational study included 38 adult patients who underwent elective placement of a percutaneous tracheostomy tube with the Ciaglia Blue Rhino introducer kit. The study was carried out from April 2002 to May 2003. The main variables analyzed were duration of the procedure, level of difficulty (easy, moderately difficult, difficult), and complications while the procedure was being performed.

RESULTS: The mean time of orotracheal intubation was 13.5 days (range, 2-28 days). The mean duration of the procedure was 12 minutes 36 seconds (range, 4 minutes 30 seconds-29 minutes; 95% confidence interval, 10 minutes 30 seconds-14 minutes 36 seconds). The procedure was rated easy in 60.5% of the cases, moderately difficult in 31.6%, and difficult in 7.9%. Some form of complication occurred in 28 patients (73.6%), the most common being puncture of the orotracheal tube (28.9%) and slight bleeding (26.3%). Two patients (5.2%) died, from massive hemorrhage in 1 case and pneumothorax in the other.

CONCLUSIONS: The Ciaglia Blue Rhino technique for percutaneous tracheotomy is useful, rapid, and easy but not free of risk. There is a learning curve that calls for caution and an experienced physician to perform the maneuvers, given that potentially fatal complications can occur.