Fig. 2

Percutaneous dilatational tracheotomy according to Ciaglia’s technique. Percutaneous dilatational tracheotomy according to Ciaglia’s technique with accompanying bronchoscopy: first, a colour Doppler ultrasound examination may be performed to ensure that no blood vessels run below the intended puncture site. After administration of local anaesthesia (A), median puncture of the trachea below the second or third tracheal clasp under bronchoscopic visualization and insertion of a Seldinger wire (B) is performed. The Seldinger guidewire is used for bougienage with different dilators (Ciaglia Blue Rhino® Set, Cook Medical) (C) under bronchoscopic visualization (D). Subsequently, the tracheal cannula is inserted along an introducer and—after bronchoscopy-guided confirmation of correct localization of the cannula within the trachea and subsequent cuff inflation—connected to the respiratory system (E). Final bronchoscopic position control of the tracheal cannula (F)