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Prevention of airway control loss during percutaneous tracheostomy
Critical Care volume 11, Article number: P218 (2007)
Loss of airway control during percutaneous tracheostomy (PCT) is one of the serious complications. It may happen due to an unstable position of the endotracheal tube (ETT) with its tip in the larynx and cuff above the vocal cords. This position of the ETT is the main request for PCT performance. We retrospectively reviewed our experience with additional use of the fiberoptic bronchoscope (FOB) and tube exchanger (TE) for stabilization of ETT during PCT.
Patients and methods
From the 160 adult critically ill patients that underwent PCT by the Griggs technique between January 2000 and August 2001, we selected 33 patients receiving anesthesia from the same anesthetist. From this group 12 patients were ventilated through ETT by the standard technique: in 11 patients a pediatric FOB was used to control and stabilize the position of ETT during PCT, and in the remaining 10 patients a 15-Fr TE was used with the same aim instead of a pediatric FOB. The optimal diameters of FOB and TE suitable for ETT (7.5 mm, 8 mm) were found in our previous experiments, using a mechanical lung simulator.
Loss of airway control during PCT occurred in three patients, where ventilation through the ETT was performed by the standard technique. This complication was corrected by expeditious actions of the anesthetist and surgeon. In the other patients, additional use of a pediatric FOB or TE has created secure and proper position of the ETT and PCT passed smoothly without complications. Moreover, we could not register a negative influence of a pediatric FOB and 15-Fr TE presence in the ETT on ventilation parameters during PCT performance.
Stabilization of the ETT position and prevention of airway control loss during PCT performance can be reached by use of a pediatric FOB or by 15-Fr TE with the same reliable results. Employment of a pediatric FOB is more expensive than a TE.
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Pirogov, A., Croitoru, M., Badaev, R. et al. Prevention of airway control loss during percutaneous tracheostomy. Crit Care 11 (Suppl 2), P218 (2007). https://doi.org/10.1186/cc5378