Comparison of the laryngeal mask airway (LMA) and cuffed oropharyngeal airway (COPA) during percutaneous tracheostomy (PCT) in ICU patients

Introduction

PCT is frequently used in ICU patients. Recent studies suggest that the use of a LMA has achieved good control of airway during PCT [1]. The COPA is a modification of the Guedel airway which allows manual ventilation by directly connecting to the breathing system [2]. We designed a prospective randomized study to compare the COPA and LMA devices during PCT in ICU patients.

Methods

In this study, a COPA or a LMA device was inserted prior to performing PCT following propofol, fentanyl and mivacurium anaesthesia. A size 9-10 COPA or size 4-5 LMA used in all patients. After oxygenation and ventilation had been adequate, PCT was performed (Sims Portex Ltd, Kent, UK). If patent airway was not provided in COPA or LMA, the devices was removed and endotracheal intubation was performed. All occuring events were documented, such as hypoxia, airway manipulations during this procedure.

Results

Patient's demographic data are in the Table. No procedure-related deaths occurred. The COPA failed in three of 23 patients (13%), the LMA failed in two of 24 patients (8%) to maintain patent airway. The number of airway interventions such as chin lift were higher in COPA group (48%). Three patients in COPA group and four patients in LMA group developed minor bleeding in peristomal area.

Table

Conclusion

Both of COPA and LMA were inserted easily with a high success rate, but airway manipulations in order to maintain patent airway were higher in COPA group. Our data suggest that COPA can be used as an alternative to LMA during PCT.