Percutaneous dilatational tracheostomy without fiber optic bronchoscopy—Evaluation of 80 intensive care units cases☆,☆☆

Simply modified percutaneous tracheostomy using the Cook® Ciaglia Blue Rhino™: a case series

“…Also, an additional physician is required and additional costs may result from damage to the FOB. Thus, several studies have assessed the safety of PDT without a FOB, including technical modifications [ 7 ] and simplified procedures [ 8 9 10 ]. Direct visualization of the larynx with a laryngoscope confirmed adequate endotracheal tube repositioning depth prior to PDT, while direct or indirect palpation of the trachea confirmed the proper tracheostomy site.…”

“…In five patients, where the underlying structures could not be adequately palpated, ultrasonography was used to identify the underlying anatomy. Another disadvantage is the lack of precise endotracheal tube repositioning, which can be achieved with a laryngoscope [ 8 9 ]. Although a FOB was used to determine the proper tube depth in 55 patients, the needle and guidewire entered the Murphy eye of the tube twice.…”

“…PDT techniques have therefore been modified to avoid the routine use of a bronchoscope while allowing PDT to be performed more safely and efficiently. Some of these modifications, which have included technical alterations [ 7 ] and the simplification of previous techniques [ 8 9 10 ], have been shown to be efficient and safe. However, the safety of modifications that omit the bronchoscope remains unclear and many have yet to be widely adopted.…”

“…Use of the Cook® Ciaglia Blue Rhino™ technique for PDT has been shown to be safe without a bronchoscope. Rather than use a bronchoscope, this approach utilizes direct palpation of the tracheal rings with or without blunt dissection of subcutaneous tissues [ 1 5 8 9 10 ]. The present study evaluated the safety of a simplified technique of PDT without the use of either a bronchoscope or blunt dissection.…”