• Paolo Tordiglione, Giuseppina Magni, Carmela Imperiale, Floriana Baisi, Nicola De Blasiis, Valentina Manganozzi, and Giovanni Rosa.
• Neuroanesthesia and Post Neurosurgical ICU, Department of Anaesthesia and Intensive Care Medicine, University of Rome 'La Sapienza', Rome, Italy. tordiglione@rocketmail.com
• Eur J Anaesthesiol. 2009 Nov 1;26(11):936-9.

Background And ObjectivePercutaneous dilational tracheostomy (PDT) is an accepted method in intensive care patients. In our neurosurgical ICU, we routinely perform PDT. We have performed 130 PDT procedures and have often observed previously reported difficulties/complications: dislocation of the endotracheal tube (ETT); frequent puncture of the ETT cuff; difficult visualization of the entire procedure because the ETT is often in the way; and risk of damaging the posterior tracheal wall due to needle puncture or rotating dilator. We believe that the rate of complications is directly related to the ability and experience of the anaesthetist carrying out the PDT. Because our hospital is a university teaching centre, PDT is often carried out by residents who are not experienced with the technique. In order to guarantee the patient's safety and to optimize the learning curve, we propose, in such circumstances, the use of a modified standard ETT.MethodWe developed a prototype tube for percutaneous tracheostomy procedures modifying a commercially available ETT. The idea was to create a protection shield for the tracheal wall, greater stability of the ETT in the trachea and improved vision during the whole procedure. We tested the effectiveness of the prototype on a manikin model.ConclusionThe dedicated ETT eliminates puncturing of the ETT, rupture of the cuff and difficult direct vision. We report an optimal stability of the tube during the whole procedure and improvement in the efficacy and safety of the procedure. When residents attempt PDF for the first time, we believe that it would be safer and more practical to perform such a technique with the dedicated ETT.

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