Percutaneous dilatational tracheostomy (PDT): a report on 103 consecutive cases of the translaryngeal tracheostomy (TLT) technique

Introduction

We describe our experience with the TIT technique, which is a purely dilatational PDT with low inherent risks. The technique has the additional benefit of maintained ventilation and airway protection.

Technique

The TLT consists of a reinforced tracheostomy tube, with an integral dilator, which is pulled out between tracheal rings following retrograde insertion through the larynx [2]. A cuffed oral 5mm-tracheal tube inserted past the proposed stoma site maintains ventilation and airway protection. We prospectively collected data in 103 consecutive patients, 56 males and 47 females, undergoing this technique. The authors (JWF & AK) performed tracheostomies on all patients (16 to 88 years old). Pre-existent coagulopathy was not corrected. Indications for tracheostomy were mainly for term ventilation (39) and weaning difficulties (44).

Results

102 tracheostomies were performed successfully. One was converted to a Ciaglia technique after accidental decannulation. Mean duration of operative procedure was 13.9 min. The INR ranged from 0.8-2.6, (mean 1.3), platelets ranged from 23-667 × 10⁹ (mean 184 × 10⁹). There were six transient episodes of hypoxia (SpO₂ < 90%), three cases of hypotension, two related to the anaesthetic technique and one following traumatic incubation. There were four episodes of accidental decannulation and one case of minor subcutaneous emphysema. There was one case of moderate blood loss (100-250 ml)). There was one episode of loss of airway, in a patient who was difficult to intubate (Gr. III). We had two cases of wound infection associated with pre-existent systemic bacteremia. Total duration of the tracheostomy ranged from 1-65 days. Total closure of the stoma took a mean of 4 days (range 2-9 days). The resultant scar was minimal.

Conclusion

This pure dilatational and bronchoscopically visualised method is easy to perform with training. It is worthy of consideration in patients with coagulation abnormalities. We feel it offers better control over the airway than other available techniques although there is a definite risk of decannulation while withdrawing the cannula over the obturator. The overall morbidity of this technique is low.