Occult Hypercarbia

Reilly, Patrick; Anderson, Harry L.; Sing, Ronald F.; Schwab, C. William; Bartlett, Robert H.

doi:10.1378/chest.107.6.1760

Cited by 90 publications

(11 citation statements)

References 20 publications

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“…The use of bronchoscopy, however, requires the availability of specialized equipment, staff and specific expertise. In patients with acute brain injury, acute elevations in intracranial pressure may occur during the performance of bronchoscopy [6]. …”

Section: Introductionmentioning

confidence: 99%

Real-time ultrasound-guided percutaneous dilatational tracheostomy: a feasibility study

et al. 2011

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IntroductionUltrasound (US) performed prior to percutaneous tracheostomy (PT) may be useful in avoiding injury to pretracheal vascular structures and in avoiding high placement of the tube. Bedside real-time US guidance with visualization of needle path is routinely utilized for other procedures such as central venous catheterization, and may enhance the safety and accuracy of PT without causing airway occlusion or hypercarbia. Our objective was to demonstrate that PT performed under real-time US guidance with visualization of needle path during tracheal puncture is feasible, including in patients with features that increase the technical difficulty of PT.MethodsMechanically ventilated patients with acute brain injury requiring tracheostomy underwent US guided PT. The orotracheal tube was withdrawn using direct laryngoscopy. The trachea was punctured under real-time US guidance (with visualization of the needle path) while using the acoustic shadows of the cricoid and the tracheal rings to identify the level of puncture. After guidewire passage the site and level of entry was verified using the bronchoscope, which was then withdrawn. Following dilatation and tube placement, placement in the airway was confirmed using auscultation and the "lung sliding" sign on US. Bronchoscopy and chest X-ray were then performed to identify any complications.ResultsThirteen patients successfully underwent US guided PT. Three patients were morbidly obese, two were in cervical spine precautions and one had a previous tracheostomy. In all 13 patients bronchoscopy confirmed that guidewire entry was through the anterior wall and between the first and fifth tracheal rings. There was no case of tube misplacement, pneumothorax, posterior wall injury, significant bleeding or other complication during the procedure.ConclusionsPercutaneous tracheostomy performed under real-time ultrasound guidance is feasible and appears accurate and safe, including in patients with morbid obesity and cervical spine precautions. Larger studies are required to further define the safety and relative benefits of this technique.Trial registrationUMIN Clinical Trials Registry, UMIN000005023.

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Section: Introductionmentioning

confidence: 99%

Real-time ultrasound-guided percutaneous dilatational tracheostomy: a feasibility study

et al. 2011

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“…Possible complications have been attributed to bronchoscopy such as increased risk for hypercarbia, respiratory acidosis, intracranial pressure, and loss of airway in some cases [14–16]. Additionally, bronchoscopy was observed to be cumbersome and sometimes unfeasible due to logistic reasons [17].…”

Section: Discussionmentioning

confidence: 99%

Open Tracheostomy after Aborted Percutaneous Approach due to Tracheoscopy Revealing Occult Tracheal Wall Ulcer

Schweiger

Sprenker

Mangar

et al. 2013

Case Reports in Anesthesiology

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Tracheostomy is a common procedure for intensive care patients requiring prolonged mechanical ventilation. In this case report, we describe a 78-year-old female patient admitted for an aneurysm of the cerebral anterior communicating artery. Following immediate endovascular coiling, she remained ventilated and was transferred to the neurological intensive care unit. On postoperative day ten, a percutaneous tracheostomy (PCT) was requested; however, a large ulcer or possible tracheoesophageal fistula was identified on the posterior tracheal wall following bronchoscopic assessment of the trachea. Therefore, the requested PCT procedure was aborted. An open tracheostomy in the operating room was completed; however, due to the position and depth of the ulcer, a reinforced endotracheal tube (ETT) was placed via the tracheostomy. Four days later, the reinforced ETT was replaced with a Shiley distal extended tracheostomy tube to bypass the ulceration. Careful inspection and evaluation of the tracheostomy site before PCT prevented a potentially life-threatening issue in our patient.

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“…The routine use of bronchoscopic guidance for PDT is controversial and high-level evidence from well-designed studies is lacking. Some authors documented fiberoptic bronchoscopy to affect gas exchange retaining carbon dioxide, to decrease partial oxygen tension, to raise intracranial pressure due to the increase in partial carbon dioxide tension, and to increase the length of time of the procedure 10,11 . On the other hand, routine use of fiberoptic bronchoscope has been shown to reduce the incidence of complications and several studies advocate its routine use 12,13 .…”

Section: T Klancir Et Almentioning

confidence: 99%

Bilateral Pneumothorax as a Complication of Percutaneous Tracheostomy: Case Report

Klancir¹,

Adam

Mršić³

et al. 2016

ACC

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SUMMARY -Percutaneous dilatational tracheostomy is a common surgical procedure that is becoming the method of choice in critically ill patients whenever prolonged airway secure and/ or ventilation support is needed. Although adverse events are relatively uncommon, serious life threatening complications can arise from this bedside procedure. We report a case of a 70-year-old female who developed extensive subcutaneous emphysema and bilateral pneumothorax immediately after a percutaneous dilatational tracheostomy procedure. Different mechanisms, such as damage to posterior or anterior tracheal wall, false passage or paratracheal placement or dislocation of the cannula are considered to be responsible for the development of pneumothorax and subcutaneous emphysema. Although bronchoscopic control after the tracheostomy procedure did not reveal any tracheal in jury, we believe that subcutaneous emphysema and bilateral pneumothorax are most likely caused by procedure induced injuries of the trachea in addition to the applied high airway pressure induced by excessive or inappropriate ventilation. In our case report, we would like to emphasize that continuous bronchoscopic guidance during percutaneous tracheostomy is invaluable in decreasing the incidence of its overall complications, especially during enhancing the team experience.

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Occult Hypercarbia

Cited by 90 publications

References 20 publications

Real-time ultrasound-guided percutaneous dilatational tracheostomy: a feasibility study

Real-time ultrasound-guided percutaneous dilatational tracheostomy: a feasibility study

Open Tracheostomy after Aborted Percutaneous Approach due to Tracheoscopy Revealing Occult Tracheal Wall Ulcer

Bilateral Pneumothorax as a Complication of Percutaneous Tracheostomy: Case Report

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