Percutaneous dilatational tracheostomy with a lightwand device

Percutaneous dilatational tracheostomy (PDT) is a new technique which shares the same indications as surgical tracheostomy. We describe our experience with the PDT in combination with tracheal transillumination.

Patient population

Elective PDT was performed in 55 critically ill patients, mean age 54.5 ± 16 (22-72), intubation time 6.5 ± 3.2 (3-14) days.

Technique

The procedure was undertaken on the bedside using the Griggs-Portex PDT set as has been already described [1]. Before cannulation of the trachea the trachlight device (trachlight, Leardal Medical) was inserted into the endotracheal tube with the tip at the end of the tube. By pulling back the endotracheal tube with the trach-light we examined the anatomy of the trachea and the location of the first and second trachea rings. Besides the proper position of the end of the tube above the first trachea ring was achieved. Afterwards we continued with the PDT technique. At the end the exact tracheotomy site and the correct placement of the tracheostomy tube was evaluated by endoscopy.

Results

The procedure lasted from 7 to 21 min (m.v. 9.5 min). The maneuver with the trachlight device lasted between 40-80s Perioperative complications are listed below:

• 1) Hemorrhage minor: 2 patients

  Hemorrhage major: 0 patients

• 2) Premature extubation of the translaryngeal tube: 0 patients

• 3) Puncture of the endotracheal tube/cuff: 0 patients

• 4) Paramedian puncture of the trachea: 0 patients

• 5) Hypoxemia: 0 patients

Conclusion

PDT is a simple bedside procedure with a low complication race. The combination with the trachlight device gives the opportunity for better identification of the anatomy of the trachea as well as the correct placement of the endotracheal tube above the first endotracheal ring. These contribute to better conditions for safe and accurate tracheal puncture and cannulation.