Use of the pro-seal laryngeal mask airway facilitates percutaneous dilatational tracheostomy in an intensive care unit

Abstract

Purpose:To study the feasibility of using the pro-seal laryngeal mask airway (LMA) for airway maintenance during bronchoscopic-guided percutaneous tracheostomy.Materials and Methods:Observational study of 60 patients in a 16-bed intensive care unit. The patient’s tracheal tube was exchanged for a pro-seal LMA before undertaking percutaneous tracheostomy.Results:Inspiratory pressure and tidal volumes achieved during the procedure were recorded. The median peak inspiratory pressure was 25 (standard deviation 4.4) cm H2O. There was no loss of tidal volume in 30 patients, a loss of less than 100 mL/breath in 27, and loss of more than 100 mL in 3 patients. A pro-seal LMA successfully maintained the airway and allowed adequate ventilation during per-cutaneous tracheostomy in all 60 patients. In all patients, fiber optic bronchoscopy through the pro-seal LMA provided a clear view of the cords and trachea and there was no laryngeal or tracheal soiling at any stage of the procedure.Conclusion:The pro-seal LMA provides a reliable airway and allows effective ventilation during percutaneous tracheostomy. The passage of a fiberscope through the pro-seal LMA and glottis is easy and provides a clear view of the upper trachea.

Laryngeal Mask Airway for Airway Control during Percutaneous Dilatational Tracheostomy

“…In two of the 23 patients in their study fluid appeared in the drain tube despite aspiration of the nasogastric tube prior to change of airway (the time of discontinuation of feeding is not reported) but no soiling of the trachea occurred. A larger observational study of 60 patients using the ProSeal LMA also reported four cases of gastric contents appearing in the drain tube despite withholding feed for six hours, aspiration of the nasogastric tube and premedication with metoclopramide 10 . Although the authors of both papers cite this as evidence of the benefits of the ProSeal LMA, no studies of other types of LMA have explicitly sought evidence of pharyngeal soiling.…”

Using a Laryngeal Mask Airway During Percutaneous Dilatational Tracheostomy is Safe and Obviates the Need for Paralytics

“…Some groups actually find increased rates of airway complications (intraoperative tube dislodgement and hypoxemia) with the LMA as opposed to ETT 14,15 ; however, bronchoscopes were not used. A few other reports cite better ventilatory ability 16,17 and airway visualization, [18][19][20] but the latter is often based on subjective scales. Hence, a Cochrane meta-analysis finds the overall quality of evidence to be low, suggests that there is insufficient information to recommend one approach versus the other and calls for additional studies.…”