Laceration of the Cuff of an Endotracheal Tube During Percutaneous Dilatational Tracheostomy

Day, Charles; Rankin, Nigel

doi:10.1378/chest.105.2.644a

Cited by 12 publications

(3 citation statements)

References 4 publications

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“…Even with such a practice cuff perforation and lacerations have been reported. [25][26][27][28][29][30] This was because the anatomic length of the adult human larynx varied from approximately 3.4-4.4 cm. 31 Since, the average length of the ETT (8.0-9.0 mm) cuffs for adults was about 3 cm and length of the tube beyond cuff also measures about 3 cm, it was possible that tracheal needle puncture can damage the endotracheal cuff or tube.…”

Section: Discussionmentioning

confidence: 99%

I gel versus endotracheal intubation for percutaneous tracheostomies: a randomised study to ascertain amicable approach

Sharma¹,

Singh²

2021

Int Surg J

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Background: Percutaneous tracheostomy or percutaneous dilation tracheostomy (PDT) is an airway management procedure routinely performed in critically ill patients, requiring prolonged ventilation. It is safely performed bedside by anaesthesiologist/intensivist in ICUs. Complications as endotracheal tube (ET) damage, loss of airway due to accidental extubation and piercing of guide wire through ET tube during procedure has led to exploration of safer/effective and viable airway alternatives while performing the procedures.Methods: In this study we randomised 60 patients to group E (ET) and group I (I gel) 30 each and studied ease of carrying out procedure and associated complication rates in both groups.Results: In ET group (group E), 9% of patients suffered with potentially catastrophic complications, e.g. loss of airway, inadequate ventilation of lungs, haemorrhage, airway leak due to ET tube cuff rupture and accidental extubation. In ETT group there was incidence of 18% cuff puncture by guide wire (p=0.025) and 3% accidental tracheal extubation. Group I witnessed lower incidence of haemorrhage (3%) and the incidence of guide wire piercing airway device was nil. Group I also demonstrated better hemodynamic stability attributed to lesser tissue trauma and airway manipulation.Conclusions: This study demonstrates enhanced safety with usage of I gel for PCDT, with less complication, better hemodynamic stability and shorter procedure duration.

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Section: Discussionmentioning

confidence: 99%

I gel versus endotracheal intubation for percutaneous tracheostomies: a randomised study to ascertain amicable approach

Sharma¹,

Singh²

2021

Int Surg J

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“…These include puncturing the cuff and transfixing the endotracheal tube (ETT) during the transtracheal needle insertion, inserting the guide wire through the Murphy's eye, or accidental extubation while withdrawing the endotracheal tube during the procedure leading to loss of the airway. [5][6][7][8][9] Although using the fingertip to palpate the trachea and endotracheal tube is a useful technique to locate the tip of the endotracheal tube during the procedure, it is unreliable, particularly in a patient with a short and thick neck. The use of a fibreoptic bronchoscope may be helpful.…”

Section: Equipmentmentioning

confidence: 99%

Light-guided tracheal puncture for percutaneous tracheostomy

Addas

Howes

Hung

2000

Can J Anesth/J Can Anesth

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Purpose: To determine the effectiveness of lightwand-guided tracheal puncture for percutaneous tracheostomy. Methods: The desired puncture site was marked on the skin of the anterior neck. A lightwand (Trachlight) was inserted into the patient's endotracheal tube (ETT), so that the number indicator on the lightwand matched the number indicator of the ETT of the patient. At this position, the light bulb of the lightwand was exactly placed at the tip of the endotracheal tube. With the lightwand turned on, the lightwand together with the endotracheal tube (ETT-LW) was slowly withdrawn from the trachea until a bright glow in the anterior neck could be seen 1 cm above the marked puncture site. At this position, the tip of the ETT was 1 cm above the puncture site.Results: Percutaneous tracheostomy via a light-guided tracheal puncture was performed on 11 neurosurgical patients. The withdrawal of the endotracheal tube to a location above the puncture was accomplished easily with the lightwand. All percutaneous tracheostomies performed were successful, with ease and without any complications. The procedure time was 17.8 ± 5.3 min. Mechanical ventilation was not interrupted during the whole procedure. Conclusion:The lightwand guided intratracheal puncture for percutaneous tracheostomy is a simple, effective, and safe procedure. This technique can avoid the risk of puncturing the endotracheal tube and/or cuff, thus allowing adequate ventilation and oxygenation during the percutaneous tracheostomy. Furthermore, this technique is inexpensive and minimizes the risk of damaging equipment like the fibreoptic bronchoscope.Objectif : Déterminer l'efficacité d'une ponction trachéale sous guidage lumineux pour réaliser une trachéotomie percutanée.Méthode : Le site de la ponction a été marqué sur la peau de la face antérieure du cou. Une tige lumineuse (Trachlight) a été insérée dans le tube endotrachéal (TET) de manière que le nombre indicateur sur la tige corresponde à celui du TET du patient. Dans cette position, l'ampoule de la tige lumineuse se trouvait exactement à la pointe du TET. Le guide allumé a été, avec le TET, lentement retiré de la trachée jusqu'à ce qu'une transillumination maximale soit observé sur la face antérieure du cou, 1 cm au-dessus du site de ponction marqué. La pointe du TET était alors à 1 cm au-dessus du site de ponction.Résultats : La trachéotomie percutanée, à l'aide d'une ponction trachéale sous guidage lumineux, a été réalisée chez 11 patients de neurochirurgie. Le positionnement du TET sous le point de ponction s'est fait facilement avec le guide lumineux. Toutes les trachéotomies percutanées ont été réussies avec facilité et sans complications. Le temps moyen requis a été de 17,8 ± 5,3 min. La ventilation mécanique a été maintenue pendant l'intervention.Conclusion : La trachéotomie réalisée grâce à la ponction trachéale sous guidage lumineux est une mesure simple, efficace et sécuritaire. La technique peut éviter de percer le tube endotrachéal et/ou le ballonnet, ce qui assure une ventilation et une...

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“…Because percutaneous tracheotomy is a blind procedure the cuff or the translaryngeal tube itself can be punctured with the introducer needle when its position is below the vocal cords [107,108]. This complication can become serious if there is a prolonged decrease of respiratory flow in patients with maximal oxygen requirements and if the cuff of the translaryngeal tube is torn and fragments are left in the trachea and bronchi [109].…”

Section: Haemorrhagementioning

confidence: 99%

Percutaneous dilatational tracheotomy

Heurn

1998

Intensivmedizin und Notfallmedizin

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Laceration of the Cuff of an Endotracheal Tube During Percutaneous Dilatational Tracheostomy

Cited by 12 publications

References 4 publications

I gel versus endotracheal intubation for percutaneous tracheostomies: a randomised study to ascertain amicable approach

I gel versus endotracheal intubation for percutaneous tracheostomies: a randomised study to ascertain amicable approach

Light-guided tracheal puncture for percutaneous tracheostomy

Percutaneous dilatational tracheotomy

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