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.

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.  

scholarly journals The effect of percutaneous and surgical tracheotomy on thyroid hormones levels

2021 ◽  
Vol 7 (2) ◽  
pp. 85
Author(s):  
Christina Sampani ◽  
Ioannis Kalemikerakis ◽  
Antonia Kalogianni ◽  
Dimitrios Papageorgiou
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Thyroid Hormones ◽  
Prolonged Mechanical Ventilation ◽  
Percutaneous Tracheostomy ◽  
Thyroid Stimulating Hormone ◽  
The Difference ◽  
The Impact ◽  
Surgical Group

Background: The need for prolonged mechanical ventilation is one of the most serious cases of a disease in patients in intensive care units. Tracheostomy is often considered as a solution when mechanical ventilation is expected to be used for prolonged periods or for improvement of the respiratory state as this approach provides protection of the airways, facilitates access to remove secretions, improves patient convenience and promotes the development of care inside and outside the Intensive Care Unit (ICU).Aim: The aim of the present study was to evaluate the impact of surgical and percutaneous tracheotomy on thyroid hormones and to compare them.Material & Methods: This is a non-randomized clinical trial. The studied sample consisted of 87 patients from the Intensive Care Unit of a General Hospital of Athens who underwent percutaneous or surgical tracheotomy.Results: Thyroid-stimulating hormone levels were increased in surgical group compared to percutaneous group at 2 hours post procedure but the difference was not found statistically significant. The rise in post-operative levels of fT3 compared to preoperative was found statistically significant for surgical tracheostomy group. Elevated fT4 levels were found in both groups.Conclusions: The effect of surgical versus percutaneous tracheostomy on thyroid hormone was analyzed and it was found that both procedures may affect the level of thyroid hormones, being significant in the surgical group.

scholarly journals Respiratory support in intensive care unit patients: the possibilities of percutaneous dilatational tracheostomy

2017 ◽  
Vol 0 (1.80) ◽  
pp. 82-86
Author(s):  
O.A. Halushko ◽  
S.I. Babak ◽  
S.O. Tretyachenko ◽  
O.O. Kobets ◽  
N.A. Hrekul
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Percutaneous Dilatational Tracheostomy ◽  
Respiratory Support ◽  
Dilatational Tracheostomy

scholarly journals Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study

2013 ◽  
pp. 184-188 ◽  
Author(s):  
Alvaro Sanabria ◽  
Ximena Gomez ◽  
Valentin Vega ◽  
Luis Carlos Dominguez ◽  
Camilo Osorio
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Critically Ill ◽  
Medical Condition ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Adult Patients ◽  
Saps Ii Score

Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.

scholarly journals A Technique to Minimize Aerosolization During Percutaneous Tracheostomy in COVID-19 Patients

2020 ◽  
Vol 86 (8) ◽  
pp. 904-906
Author(s):  
Alejandro Betancourt-Ramirez ◽  
Jay A. Yelon ◽  
Paul Boland ◽  
Michael Amaturo
Keyword(s):  
Prolonged Mechanical Ventilation ◽  
Percutaneous Tracheostomy ◽  
Percutaneous Dilatational Tracheostomy ◽  
Case Series ◽  
Surgical Intensive Care Unit ◽  
Surgical Team ◽  
Surgical Intensive Care ◽  
Level Of Evidence ◽  
Dilatational Tracheostomy ◽  
And Performance

Background The SARS-CoV-2 pandemic has caused respiratory failure in many patients. With no effective treatment or vaccine, prolonged mechanical ventilation is common in survivors. Timing and performance of tracheostomy, for both patient and surgical team safety, remains a question. Here within, we report our experience with percutaneous dilatational tracheostomy with modification to minimize aerosolization. Methods A modified percutaneous dilatational tracheostomy technique is described. The technique was performed on 10 patients in the surgical intensive care unit. Results Ten patients underwent percutaneous dilatational tracheostomy. There were 7 males, and the average age for the group was 60.8 years. The average number of ventilator days before the operation was 26.3. All procedures were successful, and no patient had any procedure-related complications. Conclusions The procedure described was successful in our patient population. We believe that this approach is safe for patients with coronavirus disease 2019 and limits aerosolization during the operation. Level of evidence Level IV, case series.

scholarly journals Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Andrei Karpov ◽  
Anish R. Mitra ◽  
Sarah Crowe ◽  
Gregory Haljan
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Respiratory Rate ◽  
Prolonged Mechanical Ventilation ◽  
Case Series ◽  
Prone Positioning ◽  
Retrospective Case ◽  
Number Of Patients

Objective and Rationale. Prone positioning of nonintubated patients has prevented intubation and mechanical ventilation in patients with respiratory failure from coronavirus disease 2019 (COVID-19). A number of patients in a recently published cohort have undergone postextubation prone positioning (PEPP) following liberation from prolonged mechanical ventilation in attempt to prevent reintubation. The objective of this study is to systematically search the literature for reports of PEPP as well as describe the feasibility and outcomes of PEPP in patients with COVID-19 respiratory failure. Design. This is a retrospective case series describing the feasibility and tolerability of postextubation prone positioning (PEPP) and its impact on physiologic parameters in a tertiary intensive care unit during the COVID-19 pandemic. Setting and Patients. This study was conducted on patients with COVID-19 respiratory failure hospitalized in a tertiary Intensive Care Unit at Surrey Memorial Hospital during the COVID-19 pandemic. Measurements and Results. We did not find prior reports of PEPP following prolonged intubation in the literature. Four patients underwent a total of 13 PEPP sessions following liberation from prolonged mechanical ventilation. Each patient underwent a median of 3 prone sessions (IQR: 2, 4.25) lasting a median of 1.5 hours (IQR: 1.2, 2.1). PEPP sessions were associated with a reduction in median oxygen requirements, patient respiratory rate, and reintubation rate. The sessions were well tolerated by patients, nursing, and the allied health team. Conclusions. The novel practice of PEPP after liberation from prolonged mechanical ventilation in patients with COVID-19 respiratory failure is feasible and well tolerated, and may be associated with favourable clinical outcomes including improvement in oxygenation and respiratory rate and a low rate of reintubation. Larger prospective studies of PEPP are warranted.

PREDICTORS OF ABILITY TO WEAN FROM PROLONGED MECHANICAL VENTILATION SIX MONTHS AFTER DISCHARGE FROM A MEDICAL INTENSIVE CARE UNIT

CHEST Journal ◽  
2005 ◽  
Vol 128 (4) ◽  
pp. 369S
Author(s):  
Leslie A. Hoffman ◽  
JiYeon Choi ◽  
Thomas H. Miller ◽  
Keiko Kobayashi ◽  
Thomas G. Zullo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Prolonged Mechanical Ventilation ◽  
Medical Intensive Care

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.

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