Feasibility and Safety of Dilatational Tracheotomy Using the Rigid Endoscope

A Multicenter Study

Andreas Nowak; Peter Kern; Sven Koscielny; Taras I. Usichenko; Klaus Hahnenkamp; Markus Jungehülsing; Matthias Tittel; Jens Oeken; Eckart Klemm

Disclosures

BMC Anesthesiol. 2017;17(7) 

In This Article

Background

PDT, performed in the ICU, should be considered the procedure of choice for performing elective tracheostomies in critically ill adult patients.[1] As an alternative to surgical tracheotomy (ST), percutaneous dilatational tracheotomy (PDT) has been increasingly used for temporary access to the trachea in the intensive care unit because it is associated with a low complication rate and is at least as safe as surgical tracheotomy in the ICU setting. Fiberoptic tracheo-bronchoscopy is the most commonly used procedure for PDT; despite the obstruction of endotracheal tube caused by the insertion of the flexible endoscope, fiberoptic tracheo-bronchoscopy decreases the incidence of complications and is recommended for routine use with PDT.[2,3] However, this procedure can be associated with major complications, including death. The well-known main causes of fatal complications are hemorrhage, airway complications, posterior tracheal wall laceration, and pneumothorax.[4] Therefore, critical care physicians are urged to consider using other tools that could provide better visualization of the tracheal anatomy to guide PDT procedures and improve airway management and safety. Recently, we suggested that the use of the rigid tracheotomy endoscope (TED) for PDT offers several advantages over the fiberoptic endoscopy technique.[5] In particular, TED use may prevent serious complications during PDT, such as posterior tracheal wall laceration, the consequences of bleeding, hypoxemia, airway loss, and equipment damage resulting from accidental puncture.[4,5] Furthermore it is still unclear, whether the tracheal ring fractures may contribute to the development of tracheal stenosis after PDT nor whether tracheal ring fractures can be prevented by using a rigid endoscope for this procedure. The use of TED for PDT, when combined with superimposed high-frequency jet ventilation (SHFJV), protects the lower respiratory tract from blood aspiration in cases of tracheal bleeding.[6]

Because the feasibility and safety of this PDT technique with TED and SHFJV were shown in a case series with 24 patients, the aim of the present study was to assess the feasibility, adverse events and complications of this new technique in a larger prospective multicenter investigation.[5]

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