Percutaneous tracheostomy in patients with cervical spine fractures - feasible and safe

Abstract

The aim of this study is to evaluate the short and long-term results of percutaneous tracheostomy in patients with documented cervical spine fracture. Between June 2000 and September 2005, 38 consecutive percutaneous tracheostomy procedures were performed on multi-trauma patients with cervical spine fracture. Modified Griggs technique was employed at the bedside in the general intensive care department. Staff thoracic surgeons and anesthesiologists performed all procedures. Demographics, anatomical conditions, presence of co-morbidities and complication rates were recorded. The average operative time was 10 min (6-15). Two patients had minor complications. One patients had minor bleeding (50 cc) and one had mild cellulitis. Nine patients had severe paraparesis or paraplegia prior to the PCT procedure and 29 were without neurological damage. There was no PCT related neurological deterioration. Twenty-eight patients were discharged from the hospital, 21 were decannulated. The average follow-up period was 18 months (1-48). There was no delayed, procedure related, complication. These results demonstrate that percutaneous tracheostomy is feasible and safe in patients with cervical spine fracture with minimal short and long-term morbidity. We believe that percutaneous tracheostomy is the procedure of choice for patients with cervical spine fracture who need prolonged ventilatory support.

Respiratory Management in the Patient with Spinal Cord Injury

“…Nun et al [83] have found percutaneous tracheostomy (PT) to be a feasible and safe procedure in patients with cervical spine fracture and available anatomical landmarks without neck extension. PT is a much quicker method, minimizes injury to the adjacent neck structures, and probably has fewer late infections of the stoma [84], which could be an important advantage in patients who have undergone anterior cervical spine fixation and who require prolonged ventilator support [85].…”

Suspension laryngoscopy‐assisted percutaneous dilatational tracheostomy in high‐risk patients

“…Most published articles consider cervical injury, pediatric age <8 years, gross distortion of the neck anatomy, and emergency airway necessity as absolute contraindications, whereas obesity with a short neck, coagulopathy, need for positive end‐expiratory pressure (PEEP) of more than 20 cm of water, and evidence of infection in the soft tissues of the neck at the prospective surgical site are relative contraindications. However, several reports have recently emerged suggesting safety and feasibility of performing PDT in patients with the previously described contraindications 12–17…”

Tracheotomia percutanea dilatativa in laringoscopia in sospensione nei pazienti affetti da COVID-19

“…The only absolute contraindications to the proposed technique are severe trismus, unstable cervical spine (fractures, hernias, syringomyelia, etc.) 16 and other anatomical conditions that do not allow good visualisation of the laryngeal plane.…”