Comparison of EtView™ tracheoscopic ventilation tube and video-assisted fiberoptic bronchoscopy during percutaneous dilatational tracheostomy

Abstract

Fiberoptic bronchoscopy (FOB) via endotracheal tube (ETT) is the most frequent utilized technique for monitoring of percutaneous dilatational tracheostomy (PDT) procedure while maintaining mechanical ventilation. Endoscopic guidance has increased the safety of this procedure; nevertheless, the use of a bronchoscope via ETT potentially may deteriorate ventilation and lead to hypercarbia and/or hypoxia. EtView tracheoscopic ventilation tube (EtView TVT) is a standard endotracheal tube with a camera and light source embedded at the tip. The objectives of this study are to introduce EtView TVT as a monitoring tool during PDT and to compare it with video assisted FOB via ETT. We hypothesized that using EtView TVT during PDT may obtain similar visualization; also may have advantages regarding better mechanical ventilation conditions when compared with video-assisted FOB via ETT. Patients, 18-75 years of age requiring mechanical ventilation scheduled for PDT were randomly allocated into two groups for airway monitorization to guide PDT procedure either with FOB via ETT (Group FOB, n = 12) or EtView TVT (Group EtView, n = 12). After standard anesthesia protocol, alveolar recruitment maneuver was applied and all patients were mechanically ventilated at pressure-controlled ventilation mode with same pressure levels. The primary outcome variable was the reduction in arterial oxygen partial pressure (PaO) values during the procedure. Other respiratory variables and the effectiveness (the visualization and identification of relevant airway structures) of two techniques were the secondary outcome variables. Patients in both groups were comparable with respect to demographic characteristics and initial respiratory variables. Visualization and identification of relevant airway structures in any steps of the PDT procedure were also comparable. The decrease in minute ventilation in Group FOB was higher when compared with Group EtView (51 ± 4 % vs. 12 ± 7.3 %, p < 0.05). The decrease in PaO from initial levels during (34 ± 21 % vs. 5 ± 7 % decrease) and after (26 ± 27 % vs. 2.8 ± 16 % decrease) the procedure was higher in Group FOB when compared with Group EtView (p < 0.05). Considering comparable features in monitorization and advantageous features over mechanical ventilation when compared with video bronchoscopy; EtView TVT would be a good alternative for airway monitorization during PDT especially for patients with poor pulmonary reserve.

The Effect of Flexible Lightwand and Ultrasonography Combination on Complications of the Percutaneous Dilatational Tracheostomy Procedure

“…For example, while the use of FOB prevents tube-related complications, it also reduces tracheal posterior wall damage to a minimum, which is one of the most frequently seen complications of the procedure. However, a worsening of ventilation leading to hypercarbia and/or hypoxia seen in approximately 16.7% of patients is the most significant disadvantage [13]. Shankar et al filled the ETT cuff with saline following the determination of the anatomic structures with USG and emphasized that damage of the tube cuff could be determined [12].…”

VivaSight single-lumen tube as an intubation method. A systematic review and meta-analysis of randomised simulation trials

“…If the camera lens is blurred by fluid from the mouth, it is possible to rinse the lens with a dedicated flushing system. Additionally, if the VivaSight SL deep endotracheal tube is inserted, it is possible to visualise the carina and introduce the bronchial blocker and one-lung ventilation without the need to confirm the position of the blocker with a fibroscope [6][7][8].…”

Comparing Percutaneous Dilatational Tracheostomy With Bronchoscopic and Ultrasound Guidance

“…As bronchoscopy may result in partial obstruction of the tracheal tube, the ventilation function of patients can be substantially impaired, with a decreased quality of ventilation and increased rates of hypercarbia and hypoxemia during the bronchoscopy-guided PDT procedure. 5,6 In contrast, because no bronchoscope is placed in the tracheal tube during the US-guided PDT procedure, the ventilation function of patients can be well preserved. 7 Thus, when assessing the safety of PDT with US and bronchoscopic guidance in critically ill patients, in addition to complications, the study design should also include intergroup comparisons with respect to the quality of ventilation, analysis of blood gases, and the PaO 2 -to-FIO 2 ratio, as performed in previous studies.…”

“…7 Thus, when assessing the safety of PDT with US and bronchoscopic guidance in critically ill patients, in addition to complications, the study design should also include intergroup comparisons with respect to the quality of ventilation, analysis of blood gases, and the PaO 2 -to-FIO 2 ratio, as performed in previous studies. [5][6][7][8] Chao Wen, MD, Fu-Shan Xue, MD , Jin-Hua Jin, MD, Qing Liu, MD…”