Percutaneous dilatational tracheostomy: Collaborative team approach for safe airway management

Following the introduction of the Ciaglia technique, PDT has become increasingly popular due to its relatively easy procedure to secure the airway. Multiple prospective studies and meta-analyses have compared PDT and ST to define the superior procedure. The results favor PDT with respect to wound infection and cosmetic sequelae. To ensure the safety of the procedure, it is indispensable to strictly observe the indications and contraindications of PDT without being preoccupied by only the handy aspect of this technique. While some authors recommend that PDT should only be performed by surgically trained individuals, others have reported that successful PDT can be performed with no association between physician specialty and complication rate as long as patient selection and bronchoscopic assistance are performed properly. Considering the present situation surrounding PDT, now may be the time to promote the collaborative multidisciplinary team approach to perform successful PDT utilizing the specialty of each participant and the benefit of this technique itself. Recent reports advocate the implementation of PDT teams consisting of otolaryngologists and either intensivists or pulmonary/critical care specialists and suggest the potential benefits of such team approaches. OurPDTteam consists of anesthesiologists and otolaryngologists, and to date the system runs smoothly. Future assessments and improvements of these approaches are warranted.