Percutaneous dilational tracheostomy: A comparison of single-versus multiple-dilator techniques

Objective: To compare the safety and efficacy of single- vs. multiple-dilator techniques in the performance of percutaneous dilational tracheostomy. Design: Prospective randomized trial. Setting: Intensive care units at a level 1 trauma center. Patients: Fifty consecutive patients requiring tracheostomy for airway control or prolonged mechanical ventilatory support. Interventions: Patients were randomized to receive a percutaneous dilational tracheostomy by either the single- or multiple-dilator technique described by Ciaglia. Measurements and Main Results: Percutaneous dilational tracheostomy was performed using the single-dilator technique in 6:01 +/- 3:03 mins and by the multiple-dilator technique in 10:01 +/- 4:26 mins (p < .0006). There were no statistically significant differences in complication rates between the two techniques. No major complications occurred with either technique. Conclusion: The single-dilator percutaneous tracheostomy technique is a safe, cost-effective, and more rapidly performed method for bedside tracheostomy in the intensive care unit.