The online version of this article (doi:10.1186/s13054-017-1901-0) contains supplementary material, which is available to authorized users.
Percutaneous dilatational tracheostomy (PDT) in critically ill patients often involves bronchoscopic optical guidance. However, this procedure is not without disadvantages. Therefore, we aimed to study a recently introduced endotracheal tube-mounted camera (VivaSightTM-SL tube [VST]; ETView, Misgav, Israel) for guiding PDT.
This was a randomized controlled trial involving 46 critically ill patients who received PDT using optical guidance with a VST or with bronchoscopy. The primary outcome measure was visualization of the tracheal structures (i.e., identification and monitoring of the thyroid, cricoid, and tracheal cartilage and the posterior wall) rated on 4-point Likert scales. Secondary measures were the quality of ventilation (before puncture and during the tracheostomy procedure rated on 4-point Likert scales) and blood gases sampled at standardized time points.
The mean ratings for visualization (lower values better; values given for per-protocol analysis) were 5.4 (95% CI 4.5–6.3) for the VST group and 4.0 (95% CI 4.0–4.0) for the bronchoscopy group (p < 0.001). Mean ventilation ratings were 2.5 (95% CI 2.1–2.9) for VST and 5.0 (95% CI 4.4–5.7) for bronchoscopy (p < 0.001). Arterial carbon dioxide increased to 5.9 (95% CI 5.4–6.5) kPa in the VST group vs. 8.3 (95% CI 7.2–9.5) kPa in the bronchoscopy group (p < 0.001), and pH decreased to 7.40 (95% CI 7.36–7.43) in the VST group vs. 7.26 (95% CI 7.22–7.30) in the bronchoscopy group (p < 0.001), at the end of the intervention.
Visualization of PDT with the VST is not noninferior to guidance by bronchoscopy. Ventilation is superior with less hypercarbia with the VST. Because visualization is not a prerequisite for PDT, patients requiring stable ventilation with normocarbia may benefit from PDT with the VST.
ClinicalTrials.gov, NCT02861001. Registered on 13 June 2016.
Additional file 1: Table S1. Arterial blood gases and respiratory values (intention to treat analysis). (PDF 43 kb)
Additional file 3: Figure S1. Rating of visualization and ventilation according to score (intention to treat analysis). (PDF 38 kb)
Australian and New Zealand Intensive Care Society (ANZICS). Percutaneous dilatational tracheostomy consensus statement. Carlton, Australia: ANZICS; 2014.
Gobatto AL, Besen BA, Tierno PF, Mendes PV, Cadamuro F, Joelsons D, Melro L, Carmona MJ, Santori G, Pelosi P, et al. Ultrasound-guided percutaneous dilational tracheostomy versus bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients (TRACHUS): a randomized noninferiority controlled trial. Intensive Care Med. 2016;42(3):342–51. CrossRefPubMed
Likert R. A technique for the measurement of attitudes. Arch Psychol. 1932;22:5–55.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure: on behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–10. CrossRefPubMed
Gawlowski P, Smereka J, Madziala M, Cohen B, Ruetzler K, Szarpak L. Comparison of the ETView Single Lumen and Macintosh laryngoscopes for endotracheal intubation in an airway manikin with immobilized cervical spine by novice paramedics: a randomized crossover manikin trial. Medicine (Baltimore). 2017;96(16):e5873. CrossRef
Kurowski A, Szarpak L, Truszewski Z, Czyzewski L. Can the ETView VivaSight SL rival conventional intubation using the Macintosh laryngoscope during adult resuscitation by novice physicians? A randomized crossover manikin study. Medicine (Baltimore). 2015;94(21):e850. CrossRef
Truszewski Z, Szarpak L, Czyzewski L, Evrin T, Kurowski A, Majer J, Karczewska K. A comparison of the ETView VivaSight SL against a fiberoptic bronchoscope for nasotracheal intubation of multitrauma patients during resuscitation: a randomized, crossover, manikin study. Am J Emerg Med. 2015;33(8):1097–9. CrossRefPubMed
Truszewski Z, Szarpak L, Smereka J, Kurowski A, Evrin T, Czyzewski L. Comparison of the VivaSight single lumen endotracheal tube and the Macintosh laryngoscope for emergency intubation by experienced paramedics in a standardized airway manikin with restricted access: a randomized, crossover trial. Am J Emerg Med. 2016;34(5):929–30. CrossRefPubMed
Truszewski Z, Krajewski P, Fudalej M, Smereka J, Frass M, Robak O, Nguyen B, Ruetzler K, Szarpak L. A comparison of a traditional endotracheal tube versus ETView SL in endotracheal intubation during different emergency conditions: a randomized, crossover cadaver trial. Medicine (Baltimore). 2016;95(44):e5170. CrossRef
Saritas A, Kurnaz MM. Comparison of bronchoscopy-guided and real-time ultrasound-guided percutaneous dilatational tracheostomy: safety, complications, and effectiveness in critically ill patients. J Intensive Care Med. doi: 10.1177/0885066617705641. https://www.ncbi.nlm.nih.gov/pubmed/28446075.
Gobatto AL, Besen BA, Tierno PF, Mendes PV, Cadamuro F, Joelsons D, Melro L, Park M, Malbouisson LM. Comparison between ultrasound- and bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients: a retrospective cohort study. J Crit Care. 2015;30(1):22. CrossRef
Via G, Braschi A. Pathophysiology of severe pulmonary hypertension in the critically ill patient. Minerva Anestesiol. 2004;70(4):233–7. PubMed
- Bronchoscopy versus an endotracheal tube mounted camera for the peri-interventional visualization of percutaneous dilatational tracheostomy - a prospective, randomized trial (VivaPDT)
Hans O. Pinnschmidt
- BioMed Central
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