Background
Methods
Study design and patient selection
PDT procedure
Outcome and statistical analysis
Complication | Minor (Easily corrected with no sequelae) | Intermediate (Intervention required, potential for persistent sequelae) | Major (Potentially life-threatening) |
---|---|---|---|
Bleeding | Coagulated/compressed | Surgically controlled | Uncontrollable, death |
Posterior tracheal wall injury | - | Without consequences | Mediastinitis, tracheo-esophageal fistula, death |
Tracheal ring fracture | - | Reposition or resection required | Airway obstruction |
Anesthesia complication | Quickly managed | Additional intervention required | Life-threatening, death |
Special incident | Quickly managed | Additional intervention required | Life-threatening, death |
Pneumothorax | - | - | Life-threatening, death |
Desaturation SpO2 < 90% | Less than 60 s. | Additional intervention required, no hypoxia sequelae | Life-threatening, death |
Results
Age (years) | 64.0 ± 14.7 |
Body mass index (kg/m2) | 26.7 ± 5.0 |
Neck circumference (cm) | 43.1 ± 5.3 |
Crico-sternal distance (cm) | 4.4 ± 1.8 |
Grade of view (acc. Cormack & Lehane) | |
I | 104 (57.8) |
II | 66 (36.7) |
III | 8 (4.4) |
IV | 1 (0.6) |
Comorbidities | |
Immunological disorder | 8 (4.4) |
Metabolic disorder | 51 (31.5) |
Hypertension | 78 (43.8) |
COPD | 33 (18.3) |
Coagulation disorder | 8 (4.5) |
Dental status | |
No pathological findings | 96 (54.9) |
Loose teeth | 22 (12.6) |
Toothless | 57 (32.6) |
Difficult introduction of TED | 17 (9.4) |
Type of PDT procedure | |
Blue Rhino | 173 (96.1) |
Percu Twist | 0 |
TLT | 0 |
GWDF | 4 (2.2) |
Ventilation mode | |
IPPV | 94 (52.8) |
HFVJ | 59 (33.1) |
SHVJ | 25 (14.0) |
Number of required punctures | |
1 | 116 (65.5) |
2 | 48 (27.1) |
>2 | 13 (7.3) |
Phases of PDT | Total events | |||
---|---|---|---|---|
1 (puncture) | 2 (dilation) | 3 (cannula insertion) | ||
Bleeding | 3 (1.7)a
| 5 (2.8)a
| 2 (1.2) | 10 (5.5) |
Tracheal ring fracture | 2 (1.1) | 23 (13.1) | 5 (2.9) | 30 (17.1) |
Lesion of posterior tracheal wall | 1 (0.5) | 1 (0.5) | 0 | 2 (1.0) |
Pneumothorax | 0 | 0 | 0 | 0 |
Anesthesia complications | 6 (3.4) | 2 (1.1) | 0 | 8 (4.5) |
Desaturation < 90% | 7 (4.0)b
| 1 (0.6)b
| 5 (2.5) | 12 (6.5) |
Other incidents | 11 (6.2) | |||
Dental damage | 1 (0.8) | 0 | 0 | 1 (0.8) |
Loss of guide wire | 1 (0.6) | 1 (0.6) | 0 | 2 (1.2) |
Tracheal dislocation of cartilage fragments | 0 | 1 (0.6) | 0 | 1 (0.6) |
Defect of dilator | 0 | 1 (0.6) | 0 | 1 (0.6) |
Short cannula | 0 | 0 | 2 (1.2) | 2 (1.2) |
Difficult insertion of cannula | 0 | 0 | 2 (1.2) | 2 (1.2) |
Bronchial dislocation with blood clot | 0 | 0 | 1 (0.6) | 1 (0.6) |
Bleeding
Tracheal ring fractures
Posterior tracheal wall injuries
Anesthesia complications
Desaturation
Phase 1 | Phase 2 | Phase 3 | |
---|---|---|---|
% (n) | % (n) | % (n) | |
Desaturation < 90% | 4.0 (7) | 0.6 (1) | 2.9 (5) |
Lowest SpO2 mean (SD) % | 81.6 (±4.4) | 72.0 (±0.0) | 81.0 (±7.8) |
Reason for desaturation [% (n)] | |||
Reason documented | 71.4 (6) | 100 (1) | 60.0 (3) |
ARDS, insufficient HFJV | 57.1 (4a) | ||
Chest trauma, insufficient HFJV | 14.3 (1) | ||
Insufficient HFJV as a result of tilting the TED to illuminate the trachea | 14.3 (1) | ||
Bleeding | 100 (1a) | ||
Difficult insertion of cannula | 66.7 (2) | ||
Bronchospasm | 33.3 (1) | ||
Reason n. a. | 14.3 (1) | 0.0 (0) | 40.0 (2) |
Reason for desaturation [% (n)] | |||
Medical | 85.7 (6) | 100 (1) | 33.3 (1) |
Technical | 14.3 (1) | 0.0 (0) | 66.6 (2) |
Other incidents
Dental damage
Difficult intubation with TED
Reasons |
n (%) |
---|---|
Inflammatory alteration of the glottis | 2 (1.1) |
Missing endotracheal tube as a guide | 2 (1.1) |
Lack of skills, learning curve | 2 (1.1) |
Inadequate depth of anesthesia | 1 (0.6) |
Cancer of tongue base | 1 (0.6) |
Inadequate size of TED, switch to a smaller instrument required | 1 (0.6) |
Optimizing the position of TED required for ventilation | 1 (0.6) |
Total | 17 (9.4) |