Safety of percutaneous dilational tracheostomy in patients ventilated with high positive end-expiratory pressure (PEEP)

Abstract

Bronchoscopically guided PDT in our patients on high PEEP did not jeopardise oxygenation 1 h and 24 h following PDT. Accordingly, high PEEP and hypoxic respiratory failure should not be considered a general contraindication for PDT.

Risk factors associated with bleeding during and after percutaneous dilational tracheostomy*

“…Exclusion criteria were unstable cervical spine injuries and non‐palpable anatomical landmarks due to an extremely short neck, goitre or tumour. All tracheostomies were performed under general anaesthesia, with controlled ventilation with 100% oxygen and strict bronchoscopic guidance as described in detail elsewhere [7, 20]. After tracheostomy, a tracheobronchoscopy was performed routinely to remove any blood and mucus, and to inspect the posterior tracheal wall for possible injuries [21].…”

“…In our department, we have ample clinical practice in percutaneous dilational tracheostomy [7, 20, 21]. Based on our experience along with a very low bleeding risk, and in the light of absent recommendations, we performed percutaneous dilational tracheostomy during 1998–2004 irrespective of the pre‐operative coagulation status, and without correcting pre‐existing abnormal coagulation or a low platelet count, or suspending heparinisation.…”

Optimizing Perioperative Ventilation Support with Adequate Settings of Positive End-Expiratory Pressure

“…In the past three decades, a multitude of physicians and scientists dedicated themselves to identify the best PEEP levels for patients under surgeries (Beiderlinden et al, 2003, Berendes et al, 1996, Bensenor et al, 2007, as well as patients with variable diseases, such as ALI or ARDS (Badet et al, 2009, Huh et al, 2009, morbid obesity (Bohm et al, 2009, Erlandsson et al, 2006, chronic obstructive pulmonary disease (COPD) (Glerant et al, 2005, Mancebo et al, 2000, brain-injury (Shapiro andMarshall, 1978, Huynh et al, 2002), including infants (Greenough et al, 1992, Dimitriou et al, 1999. Although different terminologies and endpoints for optimizing PEEP were used (Villar, 2005), most of the approaches tried to obtain the best oxygenation while minimizing VILI as outcome.…”

Percutaneous Tracheotomy

“…It is not recommended in children, in patients with abnormal necks or large goiters, in obese patients in whom the cricoid cannot be palpated, in cases of documented tracheomalacia, in patients with abnormal coagulation or those receiving anticoagulant treatment, in patients with malignant infiltration of the central compartment of the neck, in patients with an unstable cervical spine or in cases of severe obstructive airways disease. The use of ventilation with a high positive end-expiratory pressure in cases of severe respiratory failure should not be considered a general contraindication for percutaneous tracheotomy (22).…”