Translaryngeal tracheostomy (TLT): UK clinical experience

Introduction

Sub-cricoid dilation tracheostomy has gained popularity in intensive care units throughout the world during the past 10 years [1]. We describe our experience with a new and novel method for insertion of a percutaneous tracheostomy minimising the inherent risks of bleeding, misplacement and pneumothorax which have been described with other techniques.

Technique

This percutaneous technique involves the retrograde insertion of a tracheostomy tube via the mouth and then the larynx guided by a transtracheal wire placed under direct bronchoscopic vision using a Seldinger needle method [2]. Our study involved the prospective collection of data in 40 consecutive patients undergoing this technique in our institution. All tracheostomies were performed by a single operator (JWF), on ventilator dependent patients ranging from 25 to 72 years of age with a variety of underlying pathologies.

No attempt was made to correct any pre-existent coagulopathy in these patients.

Results

All 40 tracheostomies were performed successfully. Mean duration of operative procedure was 16 min. There were no periods of critical hypoxia (< 90%) or arterial hypotension (< 75 mmHg mean). Blood loss was minimal (< 10 ml) in all cases (INR range 1.0–8.4, mean 2.6, platelet range 23–246 × 10⁹). Closure of stoma on decannulation was a mean of 2 days with minimal scar.

Conclusion

This pure dilatational and bronchoscopically visualised method is reliable, easy to perform with training and is free from serious complications. We feel that it offers benefits over techniques already available and is worthy of consideration especially in those patients with underlying risk factors.