The Effect of Flexible Lightwand and Ultrasonography Combination on Complications of the Percutaneous Dilatational Tracheostomy Procedure

Abstract

The aim of this study was to evaluate the effect of the flexible lightwand and ultrasonography (USG) combination on reducing the complications in percutaneous dilatational tracheostomy (PDT) opened with the forceps dilatation method. A retrospective examination was made of 138 patients between January 2014 and December 2018. Before starting to process, the anatomic structures of the patients were visualized with USG and the tracheostomy area was marked. Sedation and local anesthesia were applied to patients before the procedure, then the percutaneous tracheostomy was performed using the Griggs technique after confirmation of the tracheostomy localization defined with USG using the transillumination method with a flexible lightwand within an endotracheal tube. Complications that developed associated with the procedure were recorded. The mean age of the patients was 59.1±22.0 years and the mean length of stay in the intensive care unit was 42.3±35.5 days (range, 11-207 days). Overall, complications developed in 22 (15.6%) patients, of which 10.7% were early complications (1.4% related to the tube, 5.8% minor and 3.5% major complications). Tube- related complications were seen to develop in two patients. In the evaluation of the early minor complications, the most frequently seen complication was minor bleeding in 5.8% of the patients. No major vessel bleeding was determined in any patient in the early or late period. Of the late complications, the infection was seen to develop in four (2.8%) patients and stenosis in three (2.1%). The combination of flexible lightwand and USG in the PDT procedure minimized tube-related complications and contributed to the prevention of bleeding complications.

Transillumination and Point-of-Care Ultrasonography to Delineate Tracheal Deviation for Challenging Tracheostomy: A Case Report

“…In a few instances, the author has witnessed surgical tracheostomy becoming “exploratory tracheostomy” in similar circumstances and strongly advocates using this simple airway management technique. Earlier, Addas et al [ 9 ] and Boran et al [ 10 ] described lightwand use to guide intratracheal puncture for percutaneous tracheostomy.…”

Complicaciones de traqueotomías asociadas a intubaciones prolongadas. Revisión sistemática

“…Así mismo, Araujo JB et al (26), reportan tasas de: complicaciones perioperatorias leves (hemorragia 17,5%, desaturación 0,8%, atelectasia 3,5%, perforación del tubo endotraqueal 1,7%, dificultad de inserción 16,6% e imposibilidad de la finalización de técnica 1,7%); complicaciones perioperatorias graves (hemorragia 0,8% y desaturación 0,8); y, complicaciones postoperatorias (hemorragia 1,7% De la misma manera, Boran et al (33), detallan una tasa de complicaciones del 15,6%, en donde las complicaciones tempranas fueron del 10,7% destacándose la hemorragia leve en un 5,8%; en las complicaciones tardías la tasa de infección fue del 2,8% y la estenosis traqueal del 2,1%. Además, informan sobre la presencia del enfisema y neumotórax en el 0,7% de sus pacientes, señalando que estas dos complicaciones infrecuentes, quizá en su estudio se debieron a la menor experticia del médico, quien realizó la técnica atribuyendo al avance de la aguja guía de manera muy vertical lastimando la pared posterior de la tráquea.…”

Pre-procedural ultrasound assessment as a step towards the safety of percutaneous dilatational tracheostomy: a comparative study

“…6 These include the laryngeal mask airway (LMA), pre-procedure ultrasound (US) scanning, light wand for trans-illumination of the neck soft tissues, and flexible fiber optic bronchoscopy. 7,8 US can be especially useful to assess tracheal midline, pre tracheal soft tissues including type and size of blood vessels in the area of interest, the sternomastoids and infrahyoid muscles, and lastly the jugular veins and carotid arteries before PDT. 9 Also it may help inaccurate selection of size and length of the tracheostomy tube, especially in patients with an increased pre tracheal soft tissue thickness.…”