Percutaneous Tracheostomy After Trauma and Critical Illness

Ivatury, Rao R.; Siegel, John H.; Stahl, William M.; Ronald, Simon; Scorpio, Ronald J.; Gens, David

doi:10.1097/00005373-199202000-00004

Cited by 58 publications

(26 citation statements)

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“…Percutaneous dilatational tracheostomy has been introduced as an alternative to standard operative tracheostomy [2][3][4][5]. This procedure has been found to have a safety profile comparable to that of operative tracheostomy [4,7,11].…”

Section: Discussionmentioning

confidence: 99%

“…The early use of tracheostomy as a method of primary airway management has been proposed as a means to decrease pulmonary morbidity and to shorten the number of days on a ventilator, in the intensive care unit, and in hospital on line [1]. Percutaneous dilatational tracheostomy, with the positioning of the endotracheal tube performed blindly or by the Doppler method, has been introduced as an alternative to standard operative tracheostomy [2][3][4][5][6]. The percutaneous technique has been shown to be safe, with intraprocedural complication rates similar to those seen with standard surgical tracheostomy [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Hypercarbia during tracheostomy: a comparison of percutaneous endoscopic, percutaneous Doppler, and standard surgical tracheostomy

Reilly

Sing

Giberson³

et al. 1997

Intensive Care Med

158

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Continuous bronchoscopy during percutaneous tracheostomy contributes significantly to early hypoventilation, hypercarbia, and respiratory acidosis during the procedure. Percutaneous tracheostomy, when performed using the Doppler ultrasound method to position the endotracheal tube, significantly reduces CO2 retention when compared to PET. Because of a possible rise in intracranial pressure, the potential for hypercarbia should be considered when choosing the method of tracheostomy in the critically ill and/or head-injured patient, where hypercarbia may be detrimental. If PET is to be performed, steps to minimize occult hypercarbia, such as using the smallest bronchoscope available, minimizing suctioning during bronchoscopy, and minimizing the length of time the bronchoscope is in the endotracheal tube, should be undertaken.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hypercarbia during tracheostomy: a comparison of percutaneous endoscopic, percutaneous Doppler, and standard surgical tracheostomy

Reilly

Sing

Giberson³

et al. 1997

Intensive Care Med

158

View full text Add to dashboard Cite

show abstract

“…Percutaneous tracheostomy may now be the artificial airway of choice in ICU patients on long-term ventilation. Despite its technical simplicity and safety, there are a number of recognised contraindications, including difficult cervical anatomy such as short neck and unidentifiable anatomic landmarks [3,4]. Difficult anatomy is particularly common in obese patients.…”

mentioning

confidence: 99%

Peri‐operative complications during percutaneous tracheostomy in obese patients

et al. 2004

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SummaryThe safety of percutaneous tracheostomy in 73 obese patients (body mass index ‡ 27.5 kg.m )2 ) in a cohort of 474 adults was studied. Four percutaneous techniques were employed (percutaneous dilational tracheostomy, n = 48; Ciaglia Blue Rhino, n = 157; guide wire dilating forceps, n = 62, translaryngeal tracheostomy, n = 207). The overall complication rate was 43.8% (n = 32) in the obese group compared to 18.2% (n = 73) in the control group (p < 0.001). Seven (9.6%) obese patients suffered life-threatening complications compared to three non-obese patients (0.7%, p < 0.001). Obese patients had a 2.7-fold increased risk for peri-operative complications, and a 4.9-fold increased risk for serious complications. The data suggest that percutaneous tracheostomy in obese patients is associated with a considerably increased risk for peri-operative complications, especially for serious adverse events.

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“…Although tracheostomy is one of the most common ways of securing the airway, especially in cases of intra-oral dermoid cyst, it is not without its own hazards, even when carried out by an experienced surgeon [13]. The literature reports 14-45% morbidity and 1.6-16% mortality rate from tracheostomy [14,15]. In addition to the possible adverse effects of tracheostomy, one must also bear in mind that we work in a generally poor environment where patients and their relatives might not be able to afford the expensive process of general anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

Surgical excision of intra-oral dermoid cyst under local anaesthesia: a review of nine cases

Chukwuneke

Akaji

Onyeka

et al. 2010

J. Maxillofac. Oral Surg.

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Objective The purpose of this article is to highlight the effectiveness of local anaesthesia in the surgical excision of intral-oral dermoid cyst in the absence of available modern and efficient general anaesthetic options as experienced in our environment.Patients and methods A retrospective review of nine patients with intra-oral dermoid cysts seen at the oral and maxillofacial surgery units of three specialist hospitals in eastern Nigeria was carried out between 1996 and 2007. We used simple clinical findings and the aspiration technique for our provisional diagnosis and treated our patients by using local anaesthesia, which contains 2% lignocaine hydrochloride in 1: 80,000 adrenaline. Results Out of the nine cases seen, the male-to-female ratio was 2:1, representing six male and three female. The age range was 13-22 years, with a mean age of 19 years. The use of local anaesthesia was uneventful and despite the limited options of treatment and the absence of advanced imaging techniques we achieved total success and good results in all nine patients. Conclusion The anaesthetic difficulties and uncertainties associated with the management of intral-oral dermoid cysts especially in an environment that lack modern general anaesthetic options can be avoided by the use of local anaesthesia. This may, therefore, be an effective alternative to difficult and sometime expensive general anaesthetic methods used in developed countries and could be emulated by oral and maxillofacial surgeons in poorer countries.

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Percutaneous Tracheostomy After Trauma and Critical Illness

Cited by 58 publications

References 0 publications

Hypercarbia during tracheostomy: a comparison of percutaneous endoscopic, percutaneous Doppler, and standard surgical tracheostomy

Hypercarbia during tracheostomy: a comparison of percutaneous endoscopic, percutaneous Doppler, and standard surgical tracheostomy

Peri‐operative complications during percutaneous tracheostomy in obese patients

Surgical excision of intra-oral dermoid cyst under local anaesthesia: a review of nine cases

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