Outcome of bedside percutaneous tracheostomy with bronchoscopic guidance

Hinerman, Rachel; Alvarez, Francisco; Keller, Cesar A.

doi:10.1007/s001340000718

Cited by 67 publications

(46 citation statements)

References 9 publications

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“…We would disagree. FOB guidance for percutaneous tracheostomy increases the safety margin of the procedure and allows tracheal examination and confirmation of correct tracheostomy placement [34][35][36]. We considered FOB useful in these cases only if adequate visualization and airway control were achieved during the entire process.…”

Section: Discussionmentioning

confidence: 99%

Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

et al. 2013

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is properly cited.Purpose. We describe characteristics, utility, and safety of fiberoptic bronchoscopy (FOB) in an intensive care unit (ICU). Methods. Prospective and descriptive cohort of patients admitted to a respiratory ICU from March 2010 to June 2012. Results. A total of 102 FOBs were performed in 84 patients among 580 patients that were admitted to the ICU. Mean age was 48 ± 17 years. FOB was useful in 65% of diagnostic procedures and 83% of therapeutic procedures, with an overall utility of 75%. Indications and utility according to indication were pneumonia in 31 cases, utility of 52%; percutaneous tracheostomy guidance in 26 cases, utility of 100%; atelectasis in 25 cases, utility of 76%; airway exploration in 16 cases, utility of 75%; hemoptysis in two cases, utility of 100%; and difficult airway intubation in two cases, utility of 100%. A decrease in oxygen saturation (SpO 2 ) of >5% during FOB was present in 65% of cases, and other minor complications were present in 3.9% of cases. Conclusions. Reasons for performing FOB in the ICU have remained relatively stable over time with the exception of the addition of percutaneous tracheostomy guidance. Our series documents current indications and also the utility and safety of this procedure.

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Section: Discussionmentioning

confidence: 99%

Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

et al. 2013

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“…The current preoperative intubation and postoperative observation times match results in international studies (Table I). [12][13][14]19,22,25 Also, the great variation in cannulation time is reflected in literature. 15,[20][21][22]25 In contrast to other studies, patients were not selected, and 88 (26.7%) high-risk patients, of whom 13 (4%) had acute dyspnea, were included in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Of all tracheotomies, 72.9% were performed in the first 3 weeks after endotracheal intubation (Table II). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] The period of cannulation varied strongly (range, 1-730 days) (n ¼ 291). In 146 patients (49.5%), the cannula remained in situ for a time period between 1 week and 1 month (20.3% 1-7 days and 25.3% 30-90 days).…”

Section: Clinical Time Intervalsmentioning

confidence: 99%

Complications of midline‐open tracheotomy in adults

et al. 2009

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Objectives/Hypothesis: Percutaneous tracheotomy is progressively replacing open tracheotomy as a consequence of promising results of comparative studies. However, this comparison has four considerable weaknesses: 1) selected indications (high-risk patients excluded for percutaneous tracheotomy); 2) varying spectra of complications included in different studies; 3) varying operative settings (experienced surgeons exclusively, surgeons in training, or both); and 4) missing differentiation between different surgical techniques. Our study was performed to collect complete datasets of unselected patients who all underwent a tracheotomy in a uniform technique in an academic teaching hospital setting.Methods: Retrospective evaluation of all complications following 303 consecutive surgical tracheotomies (midline-open technique) performed by different surgeons and surgeons in training at one academic institution. Complications were classified and compared to results in the literature.Results: Rates of 21.5% minor and 1.0% major complications and 0% tracheotomy-related mortality were registered. The most prevalent complications were local wound infections (10.9%), intra-and postoperative hemorrhages (4.2%), and cartilage damage (1.7%). No significant difference was found for highrisk patients and emergency tracheotomies.Conclusions: Our study demonstrates that open tracheotomy is a safe procedure, particularly if performed in high-risk patients even by inexperienced surgeons. Therefore, we emphasize the advantages of the midline-open tracheotomy in an academic teaching hospital setting.

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“…D Di is sc cu us ss si io on n PDT has become increasingly popular over performing a traditional surgical tracheostomy in recent years because of its relative ease and low cost, as well as having fewer complications. 1,10,11 However, because it is a blind technique (from the surgeon's perspective) one must have assurance that the needle, guide wire, dilator, and tracheostomy tube all reside within the trachea. In the simplest form, aspiration through the needle advancing into the trachea indicates entry into that airfilled structure.…”

Section: Objectif : éValuer La Nouvelle Canule Oropharyngée Supraglotmentioning

confidence: 99%

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

Carassiti

Magnani

Alfery

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To evaluate the use of the new supraglottic airway device CobraPLA™ (CPLA) for performing percutaneous dilatational tracheotomy (PDT) utilizing continuous fibreoptic visualization of the larynx and trachea and uninterrupted airway control.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : The percutaneous tracheotomies were carried out in five patients (four males and one female; mean age 72 yr, mean height 164.6 cm, mean weight 74 kg) following the Griggs technique under continuous fibreoptic vision and airway control provided by the CPLA. The mean time required for removal of the ETT, positioning of the CPLA, and confirmation of adequate ventilation and cuff seal was 78 sec. The mean time for the entire PDT procedure was six minutes and 57 sec. In one patient a 7-mm tracheostomy cannula was used, and in the other four patients an 8-mm cannula was used.The hemodynamic and respiratory variables remained stable during the entire procedure; there were no adverse events.At no point was there any significant difficulty in placing the CPLA or in providing ventilation or oxygenation. Each procedure could be observed easily in its entirety through the FOB.

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Outcome of bedside percutaneous tracheostomy with bronchoscopic guidance

Abstract: Percutaneous dilational tracheostomy with bronchoscopic guidance is a safe procedure when performed by experienced medical intensive care personnel in tertiary care institutions. Bronchoscopy helps to reduce the risk of major complications and aids in the management of minor complications.

Cited by 67 publications

References 9 publications

Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

Complications of midline‐open tracheotomy in adults

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

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