Abstract
Several kits for percutaneous tracheostomy and cricothyrotomy are widely used in the intensive care settings. Although the principles of these techniques are simple, the procedures should be carefully performed considering the draw-backs and limitations of each technique and kit. One of the most crucial problems is the placement of preexisting tracheal tube. Withdrawal of the tracheal tube for making the intratracheal space and for bronchoscopic confirmation causes the situation that securing the airway and the maintenance of ventilation are not guaranteed. Another important problem is a large resistance to insertion of the tracheostomy tube into the trachea. In the Griggs' method, the manipulation skill of the guidewire-dilating forceps determines the difficulty in the placement of the tracheostomy tube and the incidence of related complications. Although cricothyrotomy techniques with kits seem to be easier than percutaneous tracheostomy techniques, similar care should be taken to avoid complications during the procedures. In the cricothyrotomy kit using the Seldinger method, thrust for overcoming the resistance to insertion of the tracheal cannula through the cricothyroid membrane is often required due to the step between the introducer and the tracheal cannula.
