***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: A prospect i ve study was design ed to compare two single-dilator percutaneous tracheotomy techniques , the Ciaglia BlueRhino and the Percutwist technique .  One hundred and ninety adult patients were included , 166 with the BlueRhino , a conical shaped , flexible rubber dilator , and 24 with the Percutwist , a screw like dilating device .  The procedure was performed under fiberscopy in the intensive care unit ( ICU ) . Age , body mass index ( BMI ) , indication for tracheotomy , surgical l and marks , duration of the procedure and surgical complications were recorded . Median age and indications were similar for the two groups . Dilation was successful in all patients . The mean time for surgery was shorter with the Ciaglia technique : 8 ± 3 versus 12 ± 5 min with the Percutwist technique ( P = 0.004 ) . There was no significant difference related to weight , BMI , duration of tracheotomy and complications between both groups . One posterior tracheal wall puncture was observed with the Ciaglia technique and four with the Percutwist technique . No serious complications were noted with either technique . The Percutwist technique represents an alternative to the more established Ciaglia BlueRhino technique . The Ciaglia technique is a safe and more rapid procedure for bedside tracheotomy Background : Percutaneous dilatational tracheotomy ( PT ) is safe and cost effective , and has become a routine method in intensive care units ( ICU ) , but safety concerns persist for obese patients and for patients with a high risk of bleeding . In this prospect i ve study of 1000 PTs , we have investigated whether such patient characteristics were associated with an increased procedural risk BACKGROUND The single tapered dilator ( STD ) percutaneous dilatational tracheostomy ( PDT ) technique now appears to be the single most common method of performing a tracheostomy in the critical care unit ( CCU ) . METHODS A single-centre , prospect i ve evaluation of all PDTs performed in an adult mixed surgical and medical CCU between November 2003 and October 2009 was done . All procedures were undertaken by critical care physicians . A proforma recorded intraoperative complications and technical difficulties encountered during the procedure ; all patients were followed up for a minimum of 3 months for delayed complications . RESULTS A tracheostomy was performed on 589 patients during the study period . PDT  was attempted in 576 patients and successfully completed in 572 .  PDT was ab and oned in four patients due to bleeding , with three of these subsequently undergoing surgical tracheostomy ( ST ) . ST was performed in 17 patients . Intraoperative technical difficulties were encountered in 149 ( 26 % ) cases . Sixteen ( 3 % ) procedures were deemed as having early complications . A further four ( 0.7 % ) cases had significant late complications including two tracheo-innominate fistulae ( TIF ) . Both TIF patients died as a result of their complications giving a mortality directly attributable to PDT of 0.35 % . There were no differences with respect to the occurrence of complications according to grade of operator . CONCLUSIONS PDT performed by the STD technique is a relatively safe procedure with more than 96 % of procedures performed without any early or late complications . Using this technique , more than 97 % of tracheostomies undertaken during the study period were performed percutaneously . Further audit at a national level is warranted to fully evaluate long-term complications after PDT Introduction To evaluate and compare the peri-operative and postoperative complications of the two most frequently used  percutaneous tracheostomy techniques , namely guide wire dilating forceps ( GWDF ) and Ciaglia Blue Rhino ( CBR ) . Methods A sequential cohort study with comparison of short-term and long-term peri-operative and postoperative complications was performed in the intensive care unit of the University Medical Centre in Nijmegen , The Netherl and s. In the period 1997–2000 , 171 patients underwent a tracheostomy with the GWDF technique and , in the period 2000–2003 , a further 171 patients with the CBR technique .  All complications were prospect ively registered on a st and ard form . Results There was no significant difference in major complications , either peri-operative or postoperative . We found a significant difference in minor peri-operative complications ( P < 0.01 ) and minor late complications ( P < 0.05 ) . Conclusion Despite a difference in minor complications between GWDF and CBR , both techniques seem equally reliable Objective To prospect ively compare two commonly used methods for percutaneous dilational tracheostomy ( PDT ) in critically ill patients . Design Prospect i ve , r and omized , clinical trial . Setting Trauma and general intensive care units of a university tertiary teaching hospital , which is also a level 1 trauma center . Patients One hundred critically ill patients with an indication for PDT .  Interventions PDT with the Ciaglia technique using the Ciaglia PDT introducer set and the Griggs technique using a Griggs PDT kit and guidewire dilating forceps . Measurements and Main Results Surgical time , difficulties , and surgical and anesthesia complications were measured at 0–2 hrs , 24 hrs , and 7 days postprocedure . Groups were well matched , and there were no differences between the two methods in surgical time or in anesthesia complications . Major bleeding complications were 4.4 times more frequent with the Griggs PDT kit . With the Ciaglia PDT kit , both intraoperative and at 2 and 24 hrs , surgical complications were less common ( p = .023 ) and the procedure was more often completed without expert assistance ( p = .013 ) . Tracheostomy bleeding was not associated with either anticoagulant therapy or an abnormal clotting profile . Multivariate analysis identified the predictors of PDT complications as the Griggs PDT kit ( p = .027 ) and the Acute Physiology and Chronic Health Evaluation ( APACHE ) II score ( p = .041 ) . The significant predictors of time required to complete PDT were the APACHE II score ( p = .041 ) , a less experienced operator ( p = .0001 ) , and a female patient ( p = .013 ) . Conclusions Patients experiencing PDT  with the Ciaglia PDT kit had a lower surgical complication rate ( 2 % vs. 25 % ) , less operative and postoperative bleeding , and less overall technical difficulties than did patients undergoing PDT with the Griggs PDT kit . Ciaglia PDT is , therefore , the preferred technique for percutaneous tracheostomy in critically ill patients Purpose Percutaneous tracheostomy is frequently performed in long-term ventilated patients in the intensive care unit ( ICU ) . Unfortunately , despite many years of experience , the optimal technique is still unknown , especially considering the occurrence of late complications . The purpose of this study was to determine which of the two most frequently used percutaneous tracheostomy techniques performs best with the emphasis on late complications . Methods This prospect i ve r and omized trial involved 120 patients , comparing two techniques of percutaneous tracheostomy , the guide wire dilating forceps ( GWDF ) and the single step dilatational tracheostomy ( SSDT ) technique .  Results Sixty patients in each group underwent a percutaneous tracheostomy  and were followed for up to 3 months after decannulation . The majority of complications in both groups were minor ( 58.3 % in the GWDF group and 61.7 % in the SSDT group ) . We found a trend towards more major perioperative complications in the GWDF group versus the SSDT group , 10.0 versus 1.7 % ( p = 0.06 ) . One patient in the SSDT group developed a significant tracheal stenosis . However , this may also have been related to prolonged translaryngeal intubation . Results of magnetic resonance imaging ( MRI ) investigations showed only minor tracheal changes . Only 37.5 % of patients in the GWDF group and 31.8 % in the SSDT group had no complaints after their percutaneous tracheostomy . Conclusion Compared with the GWDF , the SSDT shows a trend toward less major perioperative complications with a comparable long-term outcome BACKGROUND Balloon dilatational tracheostomy using the Ciaglia Blue Dolphin device has recently been introduced as a modification of the Ciaglia technique . The aim of this study was to compare the new Dolphin system with the single-step dilatational tracheostomy ( Ciaglia Blue Rhino ) in intensive care unit ( ICU ) patients . METHODS Consecutive patients admitted to the ICU of the Emergency Department ( Careggi Teaching Hospital , Florence , Italy ) from January 2009 to October 2009 , aged > 18 years and with an indication for percutaneous dilatational tracheostomy ( PDT ) , were enrolled . Exclusion criteria were infection/injury/malignancy of the neck , thyroid gl and hypertrophy , severe head injury with uncontrolled intracranial hypertension , and coagulopathy . Patients were r and omly assigned to undergo PDT using either the Ciaglia Blue Rhino ( n=35 ) or the Ciaglia Blue Dolphin technique ( n=35 ) . Groups were compared according to tracheal puncture , tracheal tube placement time , procedure-related complications , and bleeding . RESULTS Baseline clinical data were comparable between the two groups . Median procedure time was significantly shorter in the Rhino group compared with the Dolphin group ( 1.5 vs 4 min , P = 0.035 ) . The presence of limited intra-tracheal bleeding at bronchoscopy examination after 6 h from PDT was more frequent in the Dolphin group than in the Rhino group patients ( 68.6 % vs 34.3 % , respectively , P = 0.008 ) . No major bleeding occurred in either group . CONCLUSIONS PDT using the Ciaglia Blue Dolphin technique is a feasible and viable option in ICU patients , but the Rhino technique had a shorter execution time and seemed to be associated with fewer tracheal injuries BACKGROUND Patients requiring prolonged mechanical ventilation are not uncommon in a cardiosurgical intensive care unit . Elective tracheostomy is considered the airway treatment of choice in these patients . METHODS To evaluate different techniques for tracheostomy , we prospect ively investigated 120 patients who had conventional open ( n = 40 ) , minimally invasive percutaneous dilatational ( n = 40 ) , or translaryngeal ( n = 40 ) tracheostomy techniques .  The main areas of investigation included oxygenation index ( partial pressure of arterial oxygen divided by fraction of inspired oxygen ) , complications , infection , and cost . RESULTS The oxygenation index decreased in almost every patient , regardless of the technique used , but the extent of decrease was significantly lower in both minimally invasive techniques compared with the conventional method . Overall complication rate was 12.5 % both in open tracheostomy and in percutaneous dilatational tracheostomy , whereas no complications occurred in translaryngeal tracheostomy procedures . Bacterial contamination of the tracheostomy site was found in 35 % of the open tracheostomies , whereas no infection was seen in percutaneous dilatational or translaryngeal tracheostomies . In terms of costs , PDT ( $ 506 ) and TLT ( $ 362 ) were both much cheaper than open tracheostomy ( $ 699 ) . CONCLUSIONS Percutaneous dilatational and translaryngeal tracheostomies are safe and cost-effective procedures that can be done easily at the patient 's bedside and thus are attractive alternatives to conventional surgical tracheostomy in long-term airway access in a cardiosurgical intensive care unit CONTEXT Tracheotomy is used to replace endotracheal intubation in patients requiring prolonged ventilation ; however , there is considerable variability in the time considered optimal for performing tracheotomy . This is of clinical importance because timing is a key criterion for performing a tracheotomy  and patients who receive one require a large amount of health care re sources . OBJECTIVE To determine the effectiveness of early tracheotomy ( after 6 - 8 days of laryngeal intubation ) compared with late tracheotomy ( after 13 - 15 days of laryngeal intubation ) in reducing the incidence of pneumonia and increasing the number of ventilator-free and intensive care unit (ICU)-free days . DESIGN , SETTING , AND PATIENTS R and omized controlled trial performed in 12 Italian ICUs from June 2004 to June 2008 of 600 adult patients enrolled without lung infection , who had been ventilated for 24 hours , had a Simplified Acute Physiology Score II between 35 and 65 , and had a sequential organ failure assessment score of 5 or greater . INTERVENTION Patients who had worsening of respiratory conditions , unchanged or worse sequential organ failure assessment score , and no pneumonia 48 hours after inclusion were r and omized to early tracheotomy ( n = 209 ; 145 received tracheotomy ) or late tracheotomy ( n = 210 ; 119 received tracheotomy ) . MAIN OUTCOME MEASURES The primary endpoint was incidence of ventilator-associated pneumonia ; secondary endpoints during the 28 days immediately following r and omization were number of ventilator-free days , number of ICU-free days , and number of patients in each group who were still alive . RESULTS Ventilator-associated pneumonia was observed in 30 patients in the early tracheotomy group ( 14 % ; 95 % confidence interval [ CI ] , 10%-19 % ) and in 44 patients in the late tracheotomy group ( 21 % ; 95 % CI , 15%-26 % ) ( P = .07 ) . During the 28 days immediately following r and omization , the hazard ratio of developing ventilator-associated pneumonia was 0.66 ( 95 
    Output:
    
The different techniques and devices appeared largely equivalent , with the exception of retro grade tracheostomy , which was associated with more severe complications and more frequent need of conversion to other techniques when compared with guide wire dilating forceps and single-step dilatation techniques .
Among the six analyzed techniques , single-step dilatation technique appeared the most reliable in terms of safety and success rate .