Feasibility and safety of dilatational tracheotomy using the rigid endoscope: a multicenter study

Nowak, Andreas; Kern, Peter; Koscielny, Sven; Usichenko, Taras; Hahnenkamp, Klaus; Jungehülsing, M.; Tittel, Matthias; Oeken, Jens; Klemm, E.

doi:10.1186/s12871-017-0301-y

Cited by 11 publications

(6 citation statements)

References 19 publications

(33 reference statements)

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“…Three major complications (6%) occurred in our series. This complication rate is comparable to that of other teams using similar technique and appears to be lower than conventional percutaneous tracheostomy techniques despite the great heterogeneity of the average rates of complications estimated between 9.2 and 37.4% in published series [10,13,15,18,19]. In our series, complications occurred in patients with no intubation difficulties and with various tracheostomy indications.…”

Section: Discussionsupporting

confidence: 78%

Evaluation of percutaneous dilatational tracheostomy under laryngosuspension

Moulin

Aboussouan

Castellanos

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose To describe the technique and outcomes of percutaneous tracheostomy under laryngosuspension. Methods A consecutive series of patients who underwent percutaneous tracheostomy under laryngosuspension were reviewed for outcomes. The procedure is performed under general anesthesia and laryngosuspension. An 8.5 oral endotracheal tube is inserted and the cuff is inflated in the supraglottis, allowing access to the whole trachea and subglottis. The tube is taped to the laryngoscope. A rigid endoscope is inserted in the endotracheal tube through a swivel connector connected to the tube and the ventilation circuit. Percutaneous tracheostomy kit is used to perform dilatational tracheostomy at the desired level of the trachea under direct visual endoscopic control. Results Forty-eight patients underwent percutaneous tracheostomy under laryngosuspension. Thirty-two cases were performed in an emergency after securing the airway with endotracheal intubation. In all other cases, tracheostomy was performed as a part of an elective procedure affecting the airway or in patients requiring prolonged ventilation. More than half of patients were considered high risk by virtue of one or more of the following: morbid obesity, prior neck surgery, prior neck radiotherapy, progressive head and neck cancer, or laryngotracheal stenosis. Complications occurred in seven cases. Conclusion Percutaneous tracheostomy under laryngosuspension has the advantage of optimal control of patient ventilation and hemostasis throughout the procedure. High-quality endoscopic vision and easy access to the airway under laryngosuspension allow tracheostomy to be performed with maximum safety.

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Section: Discussionsupporting

confidence: 78%

Evaluation of percutaneous dilatational tracheostomy under laryngosuspension

Moulin

Aboussouan

Castellanos

et al. 2020

Eur Arch Otorhinolaryngol

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“…This study was a follow-up observational investigation recruiting all patients from the prospective multicenter investigation of the safety and feasibility of PDT with TED [7]. Briefly, after approval of the local ethics commission, 180 adult patients in intensive care and those scheduled for ENT surgery underwent PDT using TED in four German hospitals: Hospital Dresden-Friedrichstadt (city of Dresden), Cardiovascular Center (city of Cottbus), Hospital Ernst von Bergmann (city of Potsdam) and Hospital Chemnitz (city of Chemnitz).…”

Section: Study Design and Patient Selectionmentioning

confidence: 99%

“…All patients (for unconscious patients, the legal guardian) gave their written informed consent to participate, including the follow-up investigation, which was performed 6 months after the PDT procedure. 7…”

Section: Study Design and Patient Selectionmentioning

confidence: 99%

“…In order to provide better visualization of the tracheal anatomy and improve airway management and safety during the PDT procedure, the rigid tracheotomy endoscope (TED) was introduced [6]. The use of TED-based PDT in 180 patients was comparable to that using flexible bronchoscopy in terms of safety issues, offering the opportunity for additional jet ventilation during PDT [7], which has advantages in preventing blood aspiration in case of intratracheal bleeding [8]. However, the potential late complications of PDT, such as tracheal stenosis, remained beyond the scope of this prospective multicenter investigation [7].…”

Section: Introductionmentioning

confidence: 99%

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Safety of percutaneous dilatational tracheotomy (PDT) with the rigid tracheotomy endoscope (TED): a 6-month follow-up multicenter investigation

et al. 2021

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Background The rigid tracheotomy endoscope (TED) was recently introduced to improve the fiberoptic technique during percutaneous dilatational tracheotomy (PDT) in critically ill patients. The aim was to evaluate the long-term complications of PDT using TED equipment in a prospective multicenter investigation. Methods One hundred eighty adult patients underwent PDT using TED in four German hospitals. Patients who were alive or their guardians were contacted via telephone and interviewed using a structured questionnaire 6 months following the tracheostomy procedure. Patients with airway complaints were invited for outpatient clinical ENT examination. The incidence of adverse events related to PDT was registered. Results Of 180 patients who received tracheostomy, 137 (76.1%) were alive at the time of follow-up. None of the 43 lethal events was related to the PDT. Fifty-three (38.7%) patients were available for follow-up examination, whereas 14 (10.2%) were able to visit ENT physicians. Two (3.8%) out of 53 patients developed tracheocutaneous fistula with required surgical closure of tracheostoma. Dyspnea (7.5%), hoarseness (5.7%), stridor and swallowing difficulties (both with 3.8%) were the most common complaints. Tracheal stenosis was confirmed in 1 patient (1.88% [95% CI: 0.33; 9.93]). Conclusion The use of TED for PDT in the clinical setting is safe regarding adverse events at 6-month follow-up. The incidence of tracheal stenosis after PDT with TED is comparable with that of flexible bronchoscopy; however, its role for PDT at the intensive care unit should be clarified in further investigations.

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“…Although it can remove airway obstruction, improve the situation of respiratory obstruction and improve the prognosis of patients, the large trauma and multiple postoperative complications limited its clinical application. [4][5][6][7] The incidence of complications and mortality rate among patients undergoing tracheostomy is reported as 6%~66% and 0%~5.3% abroad. 8 Percutaneous dilational tracheostomy is a minimally invasive surgical technique developed in recent years.…”

Section: Introductionmentioning

confidence: 99%

Application value of minimally invasive percutaneous dilational tracheostomy for ICU critical patients

Gan

Dong

2019

Pak J Med Sci

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Objective: To find out the application value of minimally invasive percutaneous dilational tracheostomy in critically ill patients in intensive care unit (ICU). Methods: One hundred and forty critically ill patients who underwent tracheostomy in ICU of our hospital were included in the study from August 2016 to December 2017. They were divided into an observation group and a control group by random number table method, 70 in each group. The control group received conventional tracheotomy, while the observation group received percutaneous dilational tracheostomy. The operation time, incision length, amount of intraoperative bleeding and healing time of incision were compared between the two groups, and the changes of vital signs and complications after operation were recorded. The family members of the patients signed the informed consent. Results: The operation time, healing time and incision length of the observation group were (9.92±4.13) min, (1.31±0.21) cm and (6.91±0.72) respectively, shorter than (24.09±6.82) min, (3.40±0.65) cm and (67.48±0.61) d in the control group, and the differences were statistically significant (P<0.05). The amount of intraoperative bleeding of the observation group was (7.81±1.83) mL, less than (16.34±2.83) mL in the control group; the difference was statistically significant (P<0.05). The heart rate and oxygen saturation of the observation group before and during the operation were not significantly different (P>0.05). The heart rate of the control group during the operation was significantly higher than that before the operation (P<0.05); the oxygen saturation of the control group before and during the operation had no significant difference (P>0.05). The incidence of complications in the observation group was 24.3%, which was significantly lower than that in the control group (55.7%, X2=8.279, P=0.014). Conclusion: Minimally invasive percutaneous dilational tracheostomy has advantages of small trauma, less infection and beautiful incision, and it will not increase postoperative complications. It is of great value in the treatment of ICU critical patients. doi: https://doi.org/10.12669/pjms.36.2.594 How to cite this:Gan H, Dong A, Xu H. Application value of minimally invasive percutaneous dilational tracheostomy for ICU critical patients. Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.594 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Feasibility and safety of dilatational tracheotomy using the rigid endoscope: a multicenter study

Cited by 11 publications

References 19 publications

Evaluation of percutaneous dilatational tracheostomy under laryngosuspension

Evaluation of percutaneous dilatational tracheostomy under laryngosuspension

Safety of percutaneous dilatational tracheotomy (PDT) with the rigid tracheotomy endoscope (TED): a 6-month follow-up multicenter investigation

Application value of minimally invasive percutaneous dilational tracheostomy for ICU critical patients

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