Central venous catheter infections in cancer patients - the ICU and the Wards or is management an issue?

Abstract

Background and Goal of Study: Percutaneous Dilational Tracheostomy (PDT) facilitates the bedside insertion of a tracheostomy tube in the Intensive Care Unit. Accidental puncture of endotracheal tube (ETT) cuff and unintended tracheal extubation are the potential complications during (PDT) our purpose was to evaluate the safety and efficiency of the use of the laryngeal mask airway (LMA) during percutaneous dilatational tracheostomy under bronchoscopic guidance comparing with the ventilation via (ETT). Materials and Methods: The bedside PDT was performed in 30 critically ill patients-15 in each group: LMA group and ETT group-that fulfilled the criteria for this study: PaO 2 Ͼ 100 mmHg, PaCO 2 Ͻ 45 mmHg under intermittent positive pressure ventilation (IPPV) with a mean ventilation pressure of Ͻ25 mmHg.The positioning of the LMA was done at least 30 min before the tracheostomy was performed.Blood samples for arterial blood gas analyses were taken 5 min before the procedure (first value) and just after (1 min) the insertion of tracheostomy tube (second value). Mean arterial pressure (MAP), heart frequency (HF) and peripheral oxygen saturation (SpO 2 ), endexpiratory CO 2 and minute ventilation volume (MVV) were registered every 60 seconds. Results and Discussions:There was no significant difference in MAP, HF, SpO 2 , pH, PaO 2 , or PaCO 2 between groups before the procedure. The operating time was significantly shorter in LMA group (5.5 Ϯ 0.8 min versus 7.9 Ϯ 1.4 min, P Ͻ 0.05.). Hypercarbia was noted in 33.3% in the LMA group and 26.7% in the ETT group. Conclusion(s):The LMA provides a safe and effective alternative to an endotracheal tube for airway management during guidewire dilatating forceps tracheostomies in selected patients and prevents the difficulties associated with the use of ET such as cuff puncture, tube transection by the needle, and accidental extubation.