Introduction

All traditional techniques for percutaneous dilatation tracheostomy (PDT) have analogous procedural complications. Some of the major complications are unrecognized hypoxia, hypercarbia and respiratory acidosis. The Ciaglia Blue Dolphin (CBD) is the device for PDT that uses the radial balloon dilatation that have the advantage of a short operating time and a good safety profile.

Hypothesis
To evaluate whether the CBD procedure has a negative impact on blood gas values when it is video-guided through the laryngeal mask airway (LMA).

Methods
An observational, clinical study was conducted in adult coma patients. We report our clinical practice of 40 video-guided PDT performed using CBD technique (Cook Inc., Bloomington, USA) in consecutive patients undergoing elective tracheostomy for failure to wean and continued mechanical ventilation. Informed consent was obtained from family member. All tracheostomies were carried out under general anesthesia using a LMA. We performed the technique inflating the balloon during 25 seconds to create a tracheo-stoma. Blood samples for arterial blood gas measurements were taken before the procedure (first value) and just after the insertion of tracheostomy tube (second value).

Results
Bedside PDT with CBD technique was successfully performed in the ICU for all 40 patients. The procedures were carried out within mean time of 5.51.3 of the tracheal needle entry and with negligible blood loss in all patients. There was no significant difference in pH, PaO2, or PaCO2 between the first and second arterial blood gas values. The oxygenation did not deteriorate even in patients with gravely impaired gas exchange with a PaO2/FiO2 averaging 13042 mmHg (range 45-192 mmHg) at a PEEP of 174 mbar. The procedural drawbacks were limited to three patients requiring the repetition of balloon inflation to create an adequate tracheostoma and that was completed without respiratory interferences.

Conclusion

In all patients fiberoptic-assisted CBD, performed using a LMA, did not compromise the blood gas values during and after the procedure. CBD has been shown to be a minimally invasive alternative to the conventional techniques which may have a tendency to produce acid-base disorders. The intensivist performing PDT should be scrupulous when decide which method to use. In our ICU the CBD method has become the procedure of choice.

author contact nellodenicola@fastwebnet.it