Experience with two different techniques of percutaneous dilational tracheostomy in 54 neurosurgical patients.

We report 54 patients with critical neurosurgical diseases (16 females, 38 males, age 21-84 years, mean 63.2 years) who were treated with bedside percutaneous dilational tracheostomy (PDT) because of respiratory insufficiency due to their cerebral disease. Bronchoscopically guided PDT was performed after stabilisation of the acute stage of neurosurgical disease. In 15 cases, Ciaglia's multiple dilation technique was used, and in 39 patients the dilational forceps technique according to Griggs was performed. In 14 cases (five Ciaglia's method, nine Griggs technique), intracranial pressure (ICP) was monitored throughout the procedure. Fifty-two procedures were completed. In two cases, PDT had to be aborted because of inability to puncture the trachea. No death occurred. There was a total complication rate of 16.7%, including the aborted procedures, with 3.7% of the complications classified as severe. No increase in ICP was noted. We conclude that bedside PDT, especially with the Griggs system, is safe and effective if done under bronchoscopic control. With the standard narcotic regimen used in our patients, no increase in ICP occurred.