A prospective randomised controlled trial of the LMA Supreme vs cuffed tracheal tube as the airway device during percutaneous tracheostomy

Price, Grant; McLellan, Stuart; Paterson, Ross L; Hay, Ashley

doi:10.1111/anae.12595

Cited by 15 publications

(3 citation statements)

References 13 publications

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“…After a thorough literary investigation, we could not fi nd a study designed similarly to the present one. Most studies focus on ventilation comparing laryngeal mask airway versus endotracheal intubation as airway device used during percutaneous tracheostomy, but none compares hemodynamic parameters [3,4,5]. Some studies assess the effi cacy of laryngeal mask airway (LMA) ventilation in patients with airway stenosis [6] and report no major or minor complications.…”

Section: Discussionmentioning

confidence: 99%

Laryngeal Mask Ventilation during Tracheostomy Improves Intraoperative Hemodynamic Stability in Patients Undergoing Total Laryngectomy

Marinov

Popov

Belitova

2019

Acta Medica Bulgarica

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Background and objectives: Laryngectomy with extensive extirpational neck dissection is still the treatment of choice for patients with advanced laryngeal cancer. During the initial part of laryngectomy – tracheostomy, there is a significant upper airway obstruction, caused by the cancer process itself and worsened by surgical pressure and manipulation during creation of tracheostomy. This study aims to make comparative assessment of the patient’s hemodynamic parameters, operated using three of the most popular approaches during tracheostomy: local anesthesia with preserved spontaneous ventilation; general anesthesia with ventilation by endotracheal intubation and general anesthesia with ventilation by laryngeal mask airway. Methods: A prospective cohort study was conducted in a tertiary referral center. Sixty patients with advanced laryngeal cancer appointed for total laryngectomy, were enrolled in the study. They were randomly assigned into three groups, according to the ventilation method used during the tracheostomy. Results: Patients who underwent tracheostomy under local anesthesia displayed statistically the highest levels of SAP, DAP, MAP and heart rate intraoperatively. The group of patients who underwent tracheostomy with endotracheal intubation, also displayed significantly higher levels of hemodynamic parameters during the procedure compared with the group with laryngeal mask airway ventilation, despite the fact that both groups were under general anesthesia. Conclusions: To our knowledge, this is the first study to demonstrate that laryngeal mask ventilation during tracheostomy improves intraoperative hemodynamic stability in patients undergoing total laryngectomy compared to endotracheal intubation.

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Section: Discussionmentioning

confidence: 99%

Laryngeal Mask Ventilation during Tracheostomy Improves Intraoperative Hemodynamic Stability in Patients Undergoing Total Laryngectomy

Marinov

Popov

Belitova

2019

Acta Medica Bulgarica

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“…Use of a laryngeal mask airway is not associated with decreases in mortality, complication rate, or failure related to the procedure, but does shorten the length of the procedure by an average of 1.46 (1.01–1.92) minutes. A single randomized controlled study conducted after this meta-analysis [ 67 ] found that more patients needed conversion to another procedure and had more clinically significant complications with a laryngeal mask airway.…”

Section: Methodsmentioning

confidence: 99%

Tracheotomy in the intensive care unit: guidelines from a French expert panel

Trouillet¹,

Collange²,

Belafia³

et al. 2018

Ann. Intensive Care

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Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d’Anesthésie Réanimation) with the participation of the French Emergency Medicine Association (Société Française de Médecine d’Urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1+/−) and 6 a low level of proof (Grade 2+/−). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced.

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“…Data regarding the choice of airway during PT are mixed. Some groups actually find increased rates of airway complications (intraoperative tube dislodgement and hypoxemia) with the LMA as opposed to ETT 14,15 ; however, bronchoscopes were not used. A few other reports cite better ventilatory ability 16,17 and airway visualization, [18][19][20] but the latter is often based on subjective scales.…”

mentioning

confidence: 99%

Using a Laryngeal Mask Airway During Percutaneous Dilatational Tracheostomy is Safe and Obviates the Need for Paralytics

Sonti

Sanley

Vinayak

2019

Journal of Bronchology &Amp; Interventional Pulmonology

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Background: Bedside percutaneous tracheostomy (PT) placement in critically ill patients is performed in a variety of ways, largely driven by institutional preference. We have recently transitioned to primarily extubating the patient and placing a laryngeal mask airway (LMA) before tracheostomy insertion in lieu of retracting the endotracheal tube (ETT) in place. This allows for lower sedative use and provides a superior view of the operative field. Here, we seek to describe the safety and efficiency of that approach.Methods: This is a single-center cross-sectional study from 2014 to 2016 comparing patients who underwent PT with the ETT in place retracted to the proximal larynx versus those who were extubated and had a LMA placed. Procedural length, sedative totals, and safety outcomes were recorded.Results: In total, 125 patients underwent PT during the study period, 75 via a LMA and 50 via existing ETT. There was no difference in procedural duration (LMA: 53.5 ± 21.4 min vs. ETT: 50.4 ± 16.8; P = 0.41), total complications (LMA: 29.3% vs. 16%; P = 0.09) or major complications (4% in both groups). Cisatracurium use was significantly lower in the LMA arm (LMA: 1.0 ± 3.6 mg vs. ETT: 11.5 ± 5.9 mg; P < 0.01). Conclusion:Replacing the ETT with an LMA before PT is equally safe, does not increase total procedural duration, and all but eliminates the need for paralytic agents.

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A prospective randomised controlled trial of the LMA Supreme vs cuffed tracheal tube as the airway device during percutaneous tracheostomy

Cited by 15 publications

References 13 publications

Laryngeal Mask Ventilation during Tracheostomy Improves Intraoperative Hemodynamic Stability in Patients Undergoing Total Laryngectomy

Laryngeal Mask Ventilation during Tracheostomy Improves Intraoperative Hemodynamic Stability in Patients Undergoing Total Laryngectomy

Tracheotomy in the intensive care unit: guidelines from a French expert panel

Using a Laryngeal Mask Airway During Percutaneous Dilatational Tracheostomy is Safe and Obviates the Need for Paralytics

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