Bronchoscopic Transillumination Guidance for Open Standard Surgical Tracheostomy

Francesco Imperatore, MD, Francesco Diurno, MD, Tito Passannanti, MD, Bruno Mora, MD, Luigia Romano, MD, Luigi Occhiochiuso, MD

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Abstract and Introduction

The standard tracheostomy technique, described in 1909 by Jackson, has been increasingly used in intensive care units. Since 1957, several different types of percutaneous tracheostomy techniques have been described and performed with the support of bronchoscopic transillumination.

The authors present the case of a respiratory failure due to obstruction of the upper airway by an exceptionally large goiter, which was successfully resolved by a standard open surgical tracheostomy.

In this case, surgical tracheostomy was preceded by bronchoscopic transillumination, which facilitated identification of the appropriate tracheostomy site.

Tracheostomy is one of the oldest surgical procedures and, in the past decades, has become the method of choice in the management of patients requiring long-term mechanical ventilation.[1] Although the standard tracheostomy described in 1909 by Jackson has been extensively used in critical patients, a more simple procedure that can be performed at the bedside is needed. Since 1957, several different types of percutaneous tracheostomy techniques have been described, such as percutaneous dilatational techniques according to Ciaglia and colleagues,[2] Schachner and coworkers,[3] and Griggs and colleagues.[4]

Endoscopic guidance appears to increase the safety of this procedure and may prevent complications such as pneumothorax, subcutaneous emphysema, and paratracheal false passage previously reported with blinded percutaneous methods.[5]

To date, no data exist regarding bronchoscopic guidance during standard open surgical tracheostomy. We describe a patient who was admitted to our unit for severe respiratory failure due to an enormous goiter, which caused compression and dislocation of the trachea. In this case, respiratory failure was resolved by a tracheostomy performed with the support of bronchoscopic transillumination.

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