Percutaneous tracheostomy in the intensive care unit

Use of the pro-seal laryngeal mask airway facilitates percutaneous dilatational tracheostomy in an intensive care unit

Purpose:

To study the feasibility of using the pro-seal laryngeal mask airway (LMA) for airway maintenance during bronchoscopic-guided percutaneous tracheostomy.

Materials and Methods:

Observational study of 60 patients in a 16-bed intensive care unit. The patient’s tracheal tube was exchanged for a pro-seal LMA before undertaking percutaneous tracheostomy.

Results:

Inspiratory pressure and tidal volumes achieved during the procedure were recorded. The median peak inspiratory pressure was 25 (standard deviation 4.4) cm H2O. There was no loss of tidal volume in 30 patients, a loss of less than 100 mL/breath in 27, and loss of more than 100 mL in 3 patients. A pro-seal LMA successfully maintained the airway and allowed adequate ventilation during per-cutaneous tracheostomy in all 60 patients. In all patients, fiber optic bronchoscopy through the pro-seal LMA provided a clear view of the cords and trachea and there was no laryngeal or tracheal soiling at any stage of the procedure.

Conclusion:

The pro-seal LMA provides a reliable airway and allows effective ventilation during percutaneous tracheostomy. The passage of a fiberscope through the pro-seal LMA and glottis is easy and provides a clear view of the upper trachea.

Tracheostomy: how and when should it be done in cardiovascular surgery ICU?

BACKGROUND

The aim of this study was to assess the effect of timing and techniques of tracheostomy on mortality and morbidity in cardiovascular surgery patients.

METHODS

Between January 2000 and October 2007, a total of 19,559 cardiac and vascular operations were performed in our hospital, and 205 of these patients (1.04%) who underwent a tracheostomy procedure were included in this retrospective study.

RESULTS

Surgical tracheostomy (ST) was employed in 134 (65.4%) and percutaneous tracheostomy (PT) in 71 (34.6%) of the cases. There were 17 complications related to all tracheostomy procedures in 15 (7.3%) patients. Bleeding, requiring surgical intervention, occurred in five (3.7%) ST patients and in one (1.4%) PT patient. Cardiac arrest related to the procedure occurred in two (1.5%) ST patients. Pneumothorax occurred in three (2.2%) ST patients and in one (1.4%) PT patient, subcutaneous emphysema in three (2.2%) ST patients and in one (1.4%) PT patient, and tracheoesophageal fistula in one (0.7%) ST patient (p>0.05). The postoperative infection rate was significantly lower, and cooperation of the patients, postoperative patient mobilization, and oral feeding rates were higher in the early tracheostomy group. The multifactorial mortality rates of early (<seven days) and late tracheostomies were 71.4% and 88.1%, respectively (p=0.037).

CONCLUSIONS

We believe that both techniques can be performed safely in the ICUs. Although the need of tracheostomy is one of the foremost causes of mortality and morbidity in cardiovascular surgery patients, an early application of the procedure may have favorable effects on the expected mortality and overall infection rates of the critically ill patients.

Use of the Pro-Seal LMA facilitates percutaneous dilatational tracheostomy

PURPOSE

To study the feasibility of using the Pro-Seal laryngeal mask airway (LMA) for airway maintenance during bronchoscopic guided percutaneous tracheostomy.

METHODS

Observational study of 23 patients in an 11-bed general intensive care unit. The patient's tracheal tube was exchanged for a Pro-Seal LMA before undertaking percutaneous tracheostomy.

RESULTS

Inspiratory pressure and tidal volumes achieved during the procedure were recorded. The median peak inspiratory pressure was 25 (standard deviation 4.2) cm H(2)O. There was no loss of tidal volume in 11 patients, a loss of less than 100 mL x breath(-1) in 11, and loss of more than 100 mL in one. A Pro-Seal LMA successfully maintained the airway and allowed adequate ventilation during percutaneous tracheostomy in all 23 patients. In all patients bronchoscopy through the Pro-Seal LMA provided a clear view of the cords and trachea and there was no laryngeal or tracheal soiling at any stage of the procedure.

CONCLUSION

The Pro-Seal LMA provides a reliable airway and allows effective ventilation during percutaneous tracheostomy. The passage of a fibrescope through the Pro-Seal LMA and glottis is easy and provides a clear view of the upper trachea.