Percutaneous tracheostomy boundaries revisited

Kizhner, Victor; Bertetti, Richard; Robert, Lebovics

doi:10.1016/j.anl.2014.08.005

Cited by 6 publications

(1 citation statement)

References 20 publications

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“…However, in PDT, the ventilator circuit needs to be opened more often and produces more viral aerosols are produced ( 8 ), thus increasing the risk of exposure due to more extensive airway manipulation ( 42 ), especially in the case of FFB guidance. FFB-guided PDT also needs more operators and patients expenses, prolonged operation time, increased frequency of airway obstruction, hypercapnia, and coughing reflex ( 43 ), all of which should be avoided during tracheotomy. In addition, intraoperative bleeding and abundant thick airway secretions can seriously affect the guiding effect of FFB.…”

Section: Discussionmentioning

confidence: 99%

A safer and more practical tracheotomy in invasive mechanical ventilated patients with COVID-19: A quality improvement study

Kang

Wang²,

Du³

et al. 2022

Front. Surg.

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ImportanceThe number of infections and deaths caused by the global epidemic of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) invasion is steadily increasing daily. In the early stages of outbreak, approximately 15%–20% of patients with coronavirus disease 2019 (COVID-19) inevitably developed severe and critically ill forms of the disease, especially elderly patients and those with several or serious comorbidities. These more severe forms of disease mainly manifest as dyspnea, reduced blood oxygen saturation, severe pneumonia, acute respiratory distress syndrome (ARDS), thus requiring prolonged advanced respiratory support, including high-flow nasal cannula (HFNC), non-invasive mechanical ventilation (NIMV), and invasive mechanical ventilation (IMV).ObjectiveThis study aimed to propose a safer and more practical tracheotomy in invasive mechanical ventilated patients with COVID-19.DesignThis is a single center quality improvement study.ParticipantsTracheotomy is a necessary and important step in airway management for COVID-19 patients with prolonged endotracheal intubation, IMV, failed extubation, and ventilator dependence. Standardized third-level protection measures and bulky personal protective equipment (PPE) may hugely impede the implementation of tracheotomy, especially when determining the optimal pre-surgical positioning for COVID-19 patients with ambiguous surface position, obesity, short neck or limited neck extension, due to vision impairment, reduced tactile sensation and motility associated with PPE. Consequently, the aim of this study was to propose a safer and more practical tracheotomy, namely percutaneous dilated tracheotomy (PDT) with delayed endotracheal intubation withdrawal under the guidance of bedside ultrasonography without the conventional use of flexible fiberoptic bronchoscopy (FFB), which can accurately determine the optimal pre-surgical positioning, as well as avoid intraoperative damage of the posterior tracheal wall and prevent the occurrence of tracheoesophageal fistula (TEF).

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Section: Discussionmentioning

confidence: 99%

A safer and more practical tracheotomy in invasive mechanical ventilated patients with COVID-19: A quality improvement study

Kang

Wang²,

Du³

et al. 2022

Front. Surg.

View full text Add to dashboard Cite

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Percutaneous Tracheostomy Via Grigg's Technique in Children: Does Age and Size Matter?

Sozduyar,

Ergun,

Khalilova

et al. 2024

The Laryngoscope

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ObjectivesPercutaneous tracheostomy is rarely performed in children, especially in infants. In the present study, we aimed to evaluate the complications and outcomes of PT via the Griggs technique according to the age and size of pediatric patients.MethodsThis study included 110 PICU patients who underwent PT using the Griggs technique between 2012 and 2020. The patients were divided into six groups according to their age, demographic data, primary disease, mean duration of intubation before PT, mean duration of PICU and hospitalization after PT, complications, and decannulation outcomes were compared between these groups.ResultsThe mean age and mean weight of the patients were 43.6 ± 58.9 months (1 month–207 months) and 14.6 ± 14.9 kg (2.6–65 kg), respectively. Mean intubation times before the procedures were 64.6 ± 40 days and 38.6 ± 37.9. Thirty‐seven (33.6%) infants were under 6 months of age(Group 1). There were no intraoperative complications. Tracheostomy site stenosis was significantly greater in Group 1 than in the other age groups (p = 0.032). Granuloma formation and dermatitis incidence were similar in all age groups.ConclusionPT is a safe and feasible procedure even in small infants. The accidental decannulation risk is lower than standard tracheostomy. Interacting with rigid bronchoscopy guidance is essential to perform a safer procedure. The first tracheostomy change after PT in small infants under 6 months of age, the possibility of tracheostomy site (stoma) stenosis should be considered.Level of EvidenceLevel III Laryngoscope, 2024

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