scholarly journals The Use of Fiberoptic Bronchoscopy During Percutaneous Dilatational Tracheostomy With Laryngeal Mask

1997 ◽  
Vol 4 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Maurizio Rossi ◽  
Marco De Monti ◽  
Davide Sonnino ◽  
Bruno Giacometti
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Percutaneous Dilatational Tracheostomy ◽  
Fiberoptic Bronchoscopy ◽  
Laryngeal Mask ◽  
Obese Patients ◽  
Limited Mobility ◽  
Dilatational Tracheostomy ◽  
Combined Use

The aim of our research is to evaluate the advantage by the combined use of fiberoptic bronchoscopy and laryngeal mask during the performance of percutaneous dilatational tracheostomy in an intensive care unit.Patients: 16 adult patients who were candidates to middle-long term mechanical ventilation.Environment: Intensive Care Unit of a Community General Hospital.Results: We experienced 3 minor complications (2 minor bleedings and 1 neck emphysema). Difficulties were found in 3 patients with particular anatomical conformation (obese patients with short neck and limited mobility of the cervical spine).Conclusion: The combined use of fiberoptic tracheo-bronchoscopy with the laryngeal mask permits a better endoscopic visualisation of the operatory field, providing a more secure and precise procedure.

scholarly journals Fiberoptic bronchoscope guided percutaneous dilatational tracheostomy in intensive care unit: a prospective observational study

2015 ◽  
Vol 2 (2) ◽  
pp. 52-55
Author(s):  
Asfar Azimee ◽  
Taiyenjam Kennedy Singh
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Guide Wire ◽  
Percutaneous Dilatational Tracheostomy ◽  
Prospective Clinical Study ◽  
Fiberoptic Bronchoscope ◽  
Tracheal Mucosa ◽  
Dilatational Tracheostomy ◽  
Weaning Failure ◽  
The Mean

Background: The aim of the study was to evaluate the safety of fiberoptic bronchoscope guided percutaneous dilatational tracheostomy performed in the intensive care unit.Methods: This was a prospective clinical study done on 30 critically ill patients in Intensive care unit. A puncture was made with 16G cannula at the second or third tracheal interspace which was confirmed by the fiberoptic bronchoscope. This was followed by insertion of guide wire through the cannula followed by insertion of the guiding catheter over the guide wire. The tract was enlarged with white single stage dilator to allow placement of a standard tracheostomy tube. The procedure was continuously monitored with the fiberoptic bronchoscope. Complications were noted during procedure and till patient’s stay in Intensive care unit.Results: The study included 18 (60%) male and 12 (40%) female patients. The mean age was 64.5±8 years. Percutaneous dilatational tracheostomy was done early (<10 days) in 10 (33.3%) patients and late (>10 days) in 20 (66.7%) patients. Fentanyl was used for the procedure in all the patients and among them 8 (26.6%) patients required injection rocuronium. Average procedure duration, from incision to suture for 30 patients was 12.6± 2 minutes. Indication for tracheostomy was weaning failure in 22 (73.3%) patients and airway maintenance in 8 (26.6%) patients. The mean duration patient remained on mechanical ventilation was 12.6 days and mean length of stay in critical care unit before shifting to ward was 7.6 days after tracheostomy. Acute postprocedure complications were transient bleed in four patients (13.3%), two (6.7%) had stomal bleeding, one (3%) had tracheal mucosa laceration and another (3%) had subcutaneous emphysema. No cases of stomal infection, pneumothorax, tracheal laceration, paratracheal insertion, pneumothorax and pneumomediastinum. There was no procedure-related mortality. Conclusion: Fiberoptic bronchoscope guided percutaneous dilatational tracheostomy is safe and the method of choice for elective tracheostomy in the majority of intensive care patientsJournal of Society of Anesthesiologists of Nepal 2015; 2(2): 52-55

scholarly journals The percutaneous dilatational tracheostomy in the intensive care unit - our experience

2018 ◽  
Vol 71 (suppl. 1) ◽  
pp. 77-82
Author(s):  
Vladimir Dolinaj ◽  
Sanja Milosev ◽  
Gordana Jovanovic ◽  
Ana Andrijevic ◽  
Nensi Lalic ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Prothrombin Time ◽  
Prolonged Mechanical Ventilation ◽  
Percutaneous Tracheostomy ◽  
Percutaneous Dilatational Tracheostomy ◽  
Seldinger Technique ◽  
Dilatational Tracheostomy ◽  
Tracheal Cannula

Percutaneous tracheostomy is a commonly carried out procedure in patients in the Intensive Care Unit. Percutaneous dilatational tracheostomy consists of the introduction of a tracheal cannula from the front of the neck, through blunt dissection of the pretracheal tissues, using a guide by Seldinger technique. When percutaneous dilatational tracheostomy procedure was introduced in routine clinical practice in the Clinical Center of Vojvodina, procedural protocol was established. This Protocol includes: 1. indications, contraindications and timing for percutaneous dilatational tracheostomy, 2. assessment of the patient, 3. preparation of the patient and equipment, 4. procedure description, 5. potential complications and complication management. At our institution percutaneous dilatational tracheostomy is performed on an individual patient basis assessment within 5-7 days following translaryngeal intubation. Routinely the platelet count, activated prothrombin time and prothrombin time are checked. The patient?s neck is assessed clinicaly and by the use of fiberoptic bronchoscope and ultrasound. At our institution we use the modified Ciaglia technique of the percutaneous dilatational tracheostomy-Ciaglia Single Dilatator method with the TRACOE? experc Set vario which includes spiral rein?forced tracheal cannula. At the end of procedure fiberoptic evaluation of the tracheobroinchial tree is made and chest X-ray is done. Percutaneous dilatational tracheostomy is a simple, safe, and effective procedure performed in the Intensive Care Unit. It is the preferred technique of airway management in the Intensive Care Units in the patients requiring prolonged mechanical ventilation, tracheobronchial hygiene and weaning from mechanical ventilation.

scholarly journals Predictors of difficulty in bedside percutaneous dilatational tracheostomy: pilot study

2020 ◽  
Vol 47 ◽  
Author(s):  
LUCAS RIBEIRO TENÓRIO ◽  
MARIANNE YUMI NAKAI ◽  
JÚLIO PATROCÍNIO MORAES ◽  
MARCELO BENEDITO MENEZES ◽  
LETÍCIA DE MELO SILVA ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Pilot Study ◽  
Prospective Cohort ◽  
Percutaneous Dilatational Tracheostomy ◽  
Technical Difficulty ◽  
Single Center ◽  
Dilatational Tracheostomy ◽  
Increased Risk

ABSTRACT Introduction: percutaneous dilatational tracheostomy is currently one of the main procedures performed in an intensive care unit (ICU). However, there are no well-defined indicators of technical difficulty in performing the procedure. Objectives: to define predictors of difficulty in performing bedside percutaneous dilatational tracheostomy. Methodology: prospective cohort study encompassing 21 patients who underwent bedside percutaneous dilatational tracheostomy in the ICU at a single center. Results: Sternohyoid (SH) distance shorter than 7 cm is associated with a 50% increase in the risk of technical difficulty (OR 0.44 and p <0.03). Conclusion: the reduction in (SH) distance is related to an increased risk of difficulty in performing percutaneous dilatational tracheostomy in the ICU bed.

Comparison of Percutaneous Dilatational Tracheostomy with Open Tracheostomy in Intensive Care Unit

2019 ◽  
Vol 41 (1) ◽  
pp. 1-7
Author(s):  
Pramesh S Shrestha ◽  
Moda N Marhatta ◽  
Subhash P Acharya ◽  
Ninadini Shrestha
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Percutaneous Tracheostomy ◽  
Percutaneous Dilatational Tracheostomy ◽  
Hospital Length Of Stay ◽  
Apache Ii Score ◽  
Time Duration ◽  
Surgical Tracheostomy ◽  
Dilatational Tracheostomy ◽  
Emergency Procedures

Introduction: Tracheostomy is one of the frequent surgical procedure carried out in intensive care unit. Percutaneous tracheostomy is becoming increasingly popular compared to conventional open surgical tracheostomy in ICU. Methods: A prospective randomized trial with twenty patients in each group was conducted to compare the outcomes of percutaneous and surgical tracheostomy. Percutaneous tracheostomy was performed using Ciaglia Blue Rhino technique and surgical tracheostomy was performed using established technique. The outcomes were compared in relation to randomization to tracheostomy, completion of procedure, intra operative and post-operative complications, hospital length of stay and cost. Results: There were no major complications in either group. Most variables studied were not statistically significant. The two groups did not differ in terms of basic demographics or APACHE II score. The only variables to reach statistical significance were time duration from tracheostomy randomization to start of procedure and time taken for completion of procedure. It was mean 31.85±15.35 hours in Percutaneous Tracheostomy group and in Surgical Tracheostomy group it was mean 49.10±23.61 hours respectively (p<0.009). Time taken to perform percutaneous tracheostomy was mean 15.50±3.22 minutes and for surgical tracheostomy it was mean 20.30±3.38 minutes. (p<0.001). Conclusion: Percutaneous dilatational tracheostomy is simple, faster to perform and can be done at bedside to avoid considerable delay in the performance of open tracheostomy where there is high demand for elective and emergency procedures in operating room.  

Tracheal ring herniation following percutaneous dilatational tracheostomy and its resection under endoscopic control

1999 ◽  
Vol 113 (12) ◽  
pp. 1116-1118 ◽  
Author(s):  
J. E. Osborne ◽  
E. Z. Osman ◽  
P. Cuddihy ◽  
M. Ranta
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
General Condition ◽  
Percutaneous Dilatational Tracheostomy ◽  
Anterior Segment ◽  
Upper Airway ◽  
Tracheal Ring ◽  
Dilatational Tracheostomy ◽  
Endoscopic Control ◽  
Endoscopic Guidance

AbstractA 76-year-old patient had an elective percutaneous dilatational tracheostomy (PDT) under endoscopic control in the intensive care unit. Twelve days later when her general condition improved, two attempts at decannulation failed due to upper airway obstruction above the tracheostomy site.Bronchoscopy showed herniation of the anterior tracheal wall above the tracheostomy tube occluding 80 per cent of the lumen. The herniated anterior segment was elevated and partially resected under endoscopic guidance. The patient made a full recovery and was decannulated on the first post-operative day. Pitfalls and possible complications of PDT are discussed.

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