Tracheal cartilage fracture with the percutaneous dilatational tracheostomy, Ciaglia method.

Patient was sedated with fentanyl and midazolam. Oral cavity and pharynx were locally anesthetized with lidocaine. The ET tube was withdrawn as tube cuff was placed between vocal cords using bronchoscope. Angiocath was inserted between the first and second tracheal cartilages and a guidewire was inserted through it.. The angiocath was then withdrawn and dilator was guided to trachea.. During insertion, the inferior (second) cartilage got broken as confirmed by the bronchoscope. The tracheostomy tube was inserted and its correct position confirmed with bronchoscopy and chest x-ray. The patient was under close observation, and two weeks later, he was weaned from ventilator. For the following two months patient did not have any complication due to the fractured tracheal cartilage.