Airway control during percutaneous dilatational tracheostomy: pilot study with the intubating laryngeal mask airway

Abstract

Percutaneous dilatation tracheostomy has become a common procedure for bedside insertion of tracheostomy tubes in the intensive care unit. Management of the airway during the procedure using the laryngeal mask airway (LMA) and other methods has been described. The intubating laryngeal mask airway has several potential benefits for airway management during percutaneous dilatation tracheostomy compared with the LMA. These include the use of both the fibreoptic bronchoscope and tracheal tube if necessary. We report the results of a pilot study of 10 patients that illustrates these advantages.

Ultrasound-guided percutaneous dilatational tracheostomy with laryngeal mask airway control in a morbidly obese patient

“…1-3 However, the "blind" technique is burdened with potential complications and relative and absolute contraindications. [2][3][4] To diminish those problems, bronchoscopically or ultrasonically guided PDT is suggested and airway control maintained with LMA during the PDT 5,6,8,10 . A short, bull neck without clear anatomical landmarks in morbidly obese patients presents a relative contraindication for PDT 3,4 .…”

“…1,13 These complications, which are especially frequent in patients with short, bull necks and only short sections of trachea that are accessible to PDT, can be avoided with the use of the LMA. 6,7 In recent studies, the LMA has been described as a safe device in airway control during PDT, as well as in the difficult airway management of obese patients.…”

Airway rescue with the intubating laryngeal mask in a patient with an uexpectedly large epiglottic cyst

“…We postulate that the cyst was downfolded into the ILM bowl following initial placement and that withdrawal returned it to the correct position. The ILM has been used to facilitate tracheostomy [14]. We used a size 4 ILM in this 97 kg male rather than a size 5 to minimise the risk of impact with the epiglottic cyst.…”

Airway control via the Cobrapla™ during percutaneous dilatational tracheotomy in five patients

“…[3][4][5][6] When using an ETT during PDT, the tube must be withdrawn partially in order to insert the cannula so that there is a risk of removing the ETT accidentally or rupturing the cuff. To our knowledge, there have been no reports discussing the use of any other supraglotic device other than LMAs for managing the airway during PDT.…”