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Post-Ciaglia's technique attempted for percutaneous tracheostomy. (A) Griggs 1990, (B) Fantoni 1993, (C) "PercuTwist" 2002; quoted in Kost KM 3 . Reprinted from Kost KM. Laryngoscope 2005;115:1-30 3
Source publication
For decades, the standard technique for tracheostomy was the open, surgical technique. However, during the past 20 years, the use of percutaneous dilatational tracheostomy has been increased and shown to be a feasible and safe procedure in critically ill patients. The purpose of this report is to review the percutaneous dilatational tracheostomy te...
Context in source publication
Context 1
... technique 16 in 1993 and "PercuTwist" techni- que 17 which was suggested by Frova and Quintel in 2002 are known as representative techniques. However, each respective technique was either similar or non-su- perior than Ciaglia's technique in actual utilization or in technical aspects in spite that they were all attempted to resolve the disadvantages of Ciaglia's technique but rather had shown worse outcomes in terms of complica- tions, thus they are not being used to wider extent in comparison to Ciaglia's technique up to now (Figure 3). ...
Citations
... 19 It has also been reported as a contraindication in children according to a study by Kost as well as to a review conducted by Cho. 20,21 Obese individuals should also be managed with special care as thyroid swelling is also a contraindication for this procedure. The most commonly used technique for PDT was first described by Ciaglia et al., which was a bedside technique in which the guide wire was passed between the 2 nd and 3 rd tracheal rings. ...
Introduction Cricothyrotomy, percutaneous dilation tracheostomy, and tracheostomy are all cost-effective and safe techniques used in the management of critically ill patients who need an artificial airway other than endotracheal tube ventilation. The present study focused on enlightening on elective and emergency procedures performed on conditions present with difficult airways and also attempts to shed light on the aspects of securing an airway in anticipated and unanticipated difficult intubation.
Objective The objective of the study was to compare the three procedures conducted during difficult airway/failed intubation situations.
Methods The present retrospective observational study was conducted collecting data from patient files obtained at a tertiary healthcare center from 2013 to 2018. The difficult intubation cases were managed by ear, nose, and throat (ENT) surgeons. The study compared three methods: Cricothyrotomy, percutaneous dilation tracheostomy, and tracheostomy based on factors such as procedure duration, complications, and the instruments required for each procedure.
Results The study enrolled 85 patients, 61 males and 24 females, aged between 30 and 70 years old. To perform cricothyrotomy, only a simple blade was required. Cricothyrotomy had the shortest operating time (4.1±3.1 minutes) and the shortest time of full oxygen saturation (3 min). Percutaneous tracheostomy had the least amount of bleeding (1%). Cricothyrotomy significantly showed the least intraoperative bleeding than percutaneous dilation, tracheostomy, and tracheostomy ( p = 0.001).
Conclusion Cricothyrotomy is preferable as it takes less time to perform, causes less bleeding, and takes the least time for full oxygen saturation than tracheostomy and percutaneous dilatational tracheostomy in “can't intubate, can't oxygenate” patients.
... Serious complications may develop after percutaneous tracheostomy (7). Correct patient selection, correct determination of contraindications, appropriate bleeding profile, evaluation of drug use, appropriate preparation and appropriate technique are very important in minimizing these complications in the application of percutaneous dilatational tracheostomy (8). The percutaneous tracheostomy technique which we routinely apply, has undergone some changes in J Crit Intensive Care 2023;14:52−57 order to protect the team performing the procedure during the COVID-19 pandemic (9). ...
... Once dilatation was deemed satisfactory, the tracheostomy tube was then inserted over the guide wire or the dilator. The duration of the procedure (from skin incision to tracheostomy tube placement) and operative complications, if any, were noted after tracheostomy tube placement [6][7][8]. ...
Background:
Percutaneous tracheostomy (PT) is a common procedure in critical care medicine. No definite clinical practice guidelines recommended on the choice of the direction of skin incision, vertical or transverse for tracheostomy in critically ill patients. The objective of this retrospective study was to compare the outcomes associated with vertical and transverse skin incisions in patients undergoing PT.
Methods:
Patients who underwent PT between March 2011 and December 2015 in the intensive care unit (ICU) of a tertiary hospital were retrospectively included. PTs were performed by pulmonary intensivists at the ICU bedside using the single tapered dilator technique assisted by flexible bronchoscopy. The primary outcome was the incidence of tracheostomy site ulcers at 7 days after PT.
Results:
Of the 458 patients who underwent PT, a vertical incision was made in 27.1% and a transverse incision was made in 72.9%. There were no tracheostomy-related mortalities, and no significant difference in the incidence of immediate postoperative complications, including bleeding, tracheal ring fracture, and subcutaneous emphysema. Thirty-five patients (7.6%) developed complications within 7 days after PT, in which tracheostomy-related pressure ulcers were the most frequent. Compared with vertical incisions, transverse incisions were associated with significantly lower incidence of complications (14.1% vs. 5.4%, P = 0.001).
Conclusions:
This retrospective study showed that transverse skin incisions in PTs for critically ill patients, resulted in a significant decrease in overall complications, particularly ulcers in the tracheostomy site.
... The mechanical ventilator should be switched to the control mode, and pre-oxygenation should be ensured with 100% FiO 2 . The neck of the patient should be extended as much as possible by placing an elevator transversely under the shoulders (7). At this stage, the presence of any condition that can hinder the neck extension of the patient should be checked. ...
Percutaneous tracheostomy (PT) has become an oftenly used procedure in critically ill patients requiring prolonged mechanical ventilation in recent years. The ideal timing and techniques of PT have been topics of considerable debate. In this review, we address general issues regarding PT (indications, contraindications, timing, preparation, techniques, complications) and specifically review the literatures regarding the comparison of techniques.
... The mechanical ventilator should be switched to the control mode, and pre-oxygenation should be ensured with 100% FiO 2 . The neck of the patient should be extended as much as possible by placing an elevator transversely under the shoulders (7). At this stage, the presence of any condition that can hinder the neck extension of the patient should be checked. ...
Percutaneous tracheostomy (PT) has become an oftenly used procedure in critically ill patients requiring prolonged mechanical ventilation in recent years. The ideal timing and techniques of PT have been topics of considerable debate. In this review, we address general issues regarding PT (indications, contraindications, timing, preparation, techniques, complications) and specifically review the literatures regarding the comparison of techniques.
Objectives:
Tracheostomy is an important procedure for critically ill patients in the intensive care unit (ICU), and percutaneous dilatational tracheostomy (PDT) has gained popularity due to its safety and effectiveness. However, there is limited data comparing ultrasound-guided PDT (US-PDT) with ST. In our previous study, we reported that US-PDT had similar safety and effectiveness to ST, with a shorter procedure time. However, the study design was retrospective, and the sample size was small. Therefore, we conducted a randomized controlled trial to demonstrate the safety and efficacy of US-PDT compared to ST.
Methods:
A total of 70 patients who underwent either US-PDT (n=35) or ST (n=35) were enrolled in the study between October 20, 2020, and July 26, 2022. The patients were randomly assigned to their respective procedures. The data collected included patient clinical characteristics, procedure time and details, complications, duration of ICU stay, time taken for liberation from mechanical ventilation, and hospital mortality.
Results:
Procedure time of US-PDT was shorter than ST. (4.0 ± 2.2 mins vs 10.1 ± 4.6 mins) Incisionlength of US-PDT was also shorter than ST. (1.5 ± 0.5 cm vs 1.8 ± 0.4 cm) There were no statisticallysignificant differences with demographics, procedure details, complication, period of ICU stay, timespent for liberation from mechanical ventilation and hospital mortality.
Conclusion:
US-PDT has a similar complication rate and shorter procedure time compared with ST. Itcan be safely and effectively performed in critically ill patients and can be a potential alternative to ST.
BACKGROUND
The usage of bronchoscopy during percutaneous dilatational tracheostomy remains under debate. The proponents of bronchoscopy advocating safety of the procedure, whereas the critics raising the concerns about the cost, possible delay in the procedure, and waiting for the device.
CASE SUMMARY
We are highlighting a case of percutaneous dilatational tracheostomy where bronchoscopy aided in diagnosing a rare situation of wire entrapment within the endotracheal tube, treated by withdrawing the wire from the endotracheal tube with good outcome.
CONCLUSION
The bronchoscopy guided approach permitted early diagnosis and helped to end the procedure without complication or possible major surgery in a case of accidental wire puncture of the endotracheal tube.
Key Words: Bronchoscopy, Percutaneous, Tracheostomy, Outcome, Complication
The purpose of this design project is to create transoral steerable devices with multibending using origami-inspired techniques for tracheostomy. The modular origami joint operator (MOJO) developed in this project is a bending mechanism that uses an origami universal joint as a hinge between modules of similar shapes and different lengths. It can achieve bending angles at specific locations through mechanical actuation forces from tendons or pneumatic pressure such that it can be navigated through the oral cavity and into the trachea without the need to extend the neck or use introducers. Moreover, modules of different lengths allow for customization so that more subjects are eligible to receive tracheostomy procedures.
The first part of this report will analyze the current endotracheal tubes to review their benefits and shortcomings. Next, key performance targets and step-by-step procedures for operation devices will be listed. Following this, the proposed device, MOJO, will be compared with endotracheal tubes. The last section will present a brief discussion of safety and future developments.
Percutaneous dilatational tracheostomy (PDT) is a widely used method to perform tracheostomy in the critical care medicine for patients who need prolonged mechanical ventilation. Traditionally, PDT has been facilitated by bronchoscopy via the endotracheal tube. However, there are risks for blocking the view of correct puncture site on the trachea or being extubated unintentionally, which lead to loss of the airway. These complications are possibly due to insufficient bronchoscopic visualizations via endotracheal tube during the procedure. Using laryngeal mask airways (LMA) during PDT may overcome these problems and could provide a safer alternative method with superior visualizations of the trachea and larynx. We report a case of percutaneous tracheostomy being performed successfully under bronchoscopy with LMA in the intensive care unit.
