Chest
Clinical Investigations in Critical CareAssessment of Ventilation During the Performance of Elective Endoscopic-Guided Percutaneous Tracheostomy: Clinical Evaluation of a New Method
Section snippets
Patients
We prospectively studied 40 consecutive adult patients requiring elective tracheostomy in a general ICU of an academic institution (six beds equipped with ventilators) over a 2-year period. The study was conducted according to the principles established in the Declaration of Helsinki. Informed consent was obtained from the patients or their next of kin before each procedure. The main indications for tracheostomy were anticipated prolonged dependency on mechanical ventilation, control of the
Results
Forty adult patients underwent elective PET (Table 1). There were no significant differences between the three groups in terms of age, sex, timing, acute physiology and chronic health evaluation (APACHE) III score, and gas exchange values. All tracheostomies were successful; no significant intraprocedural complications (eg, hypoxia, bleeding, hypotension, lesion of posterior tracheal wall) were noted. In one case, during the performance of a CBR procedure, we observed the fracture of the
Discussion
Percutaneous tracheostomy has been proven to be a valid alternative to traditional, surgical tracheostomy performed in the operating room. The addition of bronchoscopic guidance has increased the safety of the procedure and may prevent complications such as the creation of a false passage, posterior tracheal wall damage, pneumothorax, and subcutaneous emphysema.4,7,16 However, the presence of the bronchoscope and of the dilators inside the lumen of the trachea could produce airway obstruction
Conclusions
The new technique we propose for the airway management during tracheostomy performance seems to be safe and effective. It is a simple and rapid technique that can be performed with materials commonly available in the ICU. This technique ensures adequate ventilation even if complications such as bleeding protract the surgical time. The results of this preliminary experience show that the method proposed might substitute for the other techniques of airway management currently in use. However, we
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Cited by (31)
A modified technique for percutaneous dilatational tracheostomy: A retrospective review of 60 cases
2016, Journal of Critical CareCitation Excerpt :The best attributes of all known PDT techniques were used to invent a slightly modified PDT technique that aims to (1) prevent accidental intraprocedural airway loss, (2) allow for uninterrupted gas exchange during PDT, (3) prevent major intraprocedural bleeding, and (4) reduce operating costs and resources. In the modified technique, the operator starts with pushing the patient's ETT distally (Fig. 1 Step 1) until a depth of 26 cm at the lips is reached or change of ventilator pressures suggest entry into a mainstem broncus at which point the ETT is slightly withdrawn so as to lie approximately at the level of the carina [19,22]. This is done to prevent puncture of the ETT balloon during needle insertion.
Response
2015, ChestTracheal ring fracture secondary to percutaneous tracheostomy: Is tracheal flaccidity a risk factor?
2015, Journal of Cardiothoracic and Vascular AnesthesiaTranslaryngeal open ventilation for percutaneous endoscopic tracheostomy
2014, British Journal of Anaesthesia