A new training approach in endoscopic percutaneous tracheostomy using a simulation model based on biological tissue.

Ciaglia et al. originally proposed the percutaneous tracheostomy in 1985 as an alternative to the surgical approach. Several variants have been developed in the years with a convincing evidence that, compared to surgical tracheostomy, the percutaneous approach is more cost--effective without compromising safety. However the procedure is not immune from complications and requires procedural skills and adequate level of expertise with a steep learning curve. In this contest, to optimize safety and efficacy of percutaneous tracheostomy in different clinical scenarios (emergency, obesity, neuro--trauma, presence of vascular abnormalities with high risk of bleeding etc.), physicians should be familiar with the different available percutaneous techniques. Traditionally, the training has been performed using manikins or animal models. However, by definition the manikin is not able to replicate the complex anatomy and does not provide a realist model for learning. We implemented a sheep model that was tested in a simulation--based course for percutaneous dilational tracheostomy and cricothyrotomy training.