Percutaneous Tracheostomy: To Bronch or Not to Bronch—That Is the Question

Jackson, La Scienya M.; Davis, James W.; Kaups, Krista L.; Sue, Lawrence P.; Wolfe, Mary M.; Bilello, John F.; Lemaster, Deborah

doi:10.1097/ta.0b013e31823ba29e

Cited by 60 publications

(64 citation statements)

References 20 publications

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“…This probably results from the addition of FOB for percutaneous tracheostomy and the definition of its utility. Some authors would argue that FOB is not mandatory for percutaneous tracheostomy [32,33]. We would disagree.…”

Section: Discussionmentioning

confidence: 98%

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: 98%

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 largest comparative study did not show a difference in complication rates with the use of video bronchoscopy. 22 In fact, the most significant complication (loss of airway and subsequent cardiac arrest) occurred in the bronchoscopy group. Although there is a lack of evidence in the literature, blind PDT without direct visualization of the trachea might be associated with an increased risk of uncentered tracheal positioning, paratracheal insertion, and posterior tracheal wall laceration or perforation with subsequent potential for increased incidence of complications based on our experience.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficiency of Percutaneous Dilatational Tracheostomy With Direct Bronchoscopic Guidance for Thoracic Transplant Recipients

et al. 2016

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BACKGROUND: Percutaneous dilatational tracheostomy (PDT) is the standard airway access in critically ill patients who require prolonged mechanical ventilation. However, the literature lacks reports about the effectiveness and safety of this procedure in thoracic organ transplant recipients, who have increased risks of bleeding and infection. METHODS: We retrospectively reviewed the records of subjects who underwent thoracic organ transplantation at our institution between January 2004 and March 2011 followed by PDT (using the Ciaglia Blue Rhino technique with direct bronchoscopic guidance). RESULTS: From a total of 312 thoracic transplant recipients, we identified 93 (29.8%) subjects with PDT. Of these, 79 had undergone double lung transplant, 11 had undergone heart transplant, 2 had undergone combined heart-lung transplant, and 1 had undergone combined heart-kidney transplant. Mean age was 49.5 ؎ 11.2 y, and 58% of subjects were female. The mean time from intubation to PDT was 3.7 ؎ 3.4 d, and mean time from transplant to PDT was 12.6 ؎ 28.3 d. Thirty-two subjects (34.4%) underwent PDT after re-intubation. Thirtynine subjects were receiving renal replacement therapy (41.9%), and 28 had a coagulopathy (30.1%). Moderate but not significant bleeding was observed in 3 subjects. There were no major complications during PDT procedures. Forty-five subjects (48.4%) could be weaned successfully from the ventilator and the tracheostoma could be removed. Forty-eight subjects (51.6%) died due to sepsis, multi-organ failure, or transplant failure. No procedure-related deaths were noted. There were no significant late complications. Among the 45 who survived their stay in the ICU, the functional and cosmetic outcomes of PDT were excellent. CONCLUSIONS: PDT can be safely performed on patients with acute respiratory failure after thoracic organ transplantation. Therefore, we recommend the use of this technique for prolonged airway management in these patients.

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“…5 Pre-procedural ultrasound examination of the neck decreases bleeding complications, whereas a DLET does not address this issue. Thus, even with a DLET, a pre-procedural ultrasound exam should be performed.…”

Section: To the Editormentioning

confidence: 99%

“…A retrospective review found no difference in PDT complications with or without bronchoscopy. 5 Only 50% of operators worldwide use bronchoscopy. 2,3 Large studies using either intermittent bronchoscopy or no bronchoscopy at all during PDT have shown very low complication rates, very low mortality, and high success rates even in high-risk subjects.…”

Section: To the Editormentioning

confidence: 99%

Are New Airway Devices for Percutaneous Dilatational Tracheostomy Really Needed?

Sangwan

2015

Respir Care

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Percutaneous Tracheostomy: To Bronch or Not to Bronch—That Is the Question

Cited by 60 publications

References 20 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?

Safety and Efficiency of Percutaneous Dilatational Tracheostomy With Direct Bronchoscopic Guidance for Thoracic Transplant Recipients

Are New Airway Devices for Percutaneous Dilatational Tracheostomy Really Needed?

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