Use of Bronchoscopy in Percutaneous Dilational Tracheostomy

Gadkaree, Shekhar K.; Schwartz, David R.; Gerold, Kevin B.; Kim, Young

doi:10.1001/jamaoto.2015.3123

Cited by 39 publications

(50 citation statements)

References 33 publications

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“…Most of the data available is from retrospective studies. The studies [109][110][111][112][113][114][115] compared PDT with and without bronchoscopy in various clinical subset and all of them concluded that PDT can be safely performed even without the aid of bronchoscope Indian Journal of Critical Care Medicine, January 2020;24(Suppl 1)…”

Section: Does the Use Of Fiberoptic Bronchoscope (Fob) While Performimentioning

confidence: 99%

Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations

Gupta¹,

Dixit²,

Choudhry

et al. 2019

Indian Journal of Critical Care Medicine

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Background and Aim: Critically ill patients on mechanical ventilation undergo tracheostomy to facilitate weaning. The practice in India may be different from the rest of the world and therefore, in order to understand this, ISCCM conducted a multicentric observational study "DIlatational percutaneous vs Surgical tracheoStomy in intEnsive Care uniT: A practice pattern observational multicenter study (DISSECT Study)" followed by an ISCCM Expert Panel committee meeting to formulate Practice recommendations pertinent to Indian ICUs. Materials and methods: All existing International guidelines on the topic, various randomized controlled trials, meta-analysis, systematic reviews, retrospective studies were taken into account to formulate the guidelines. Wherever Indian data was not available, international data was analysed. A modified Grade system was followed for grading the recommendation. Results: After analyzing the entire available data, the recommendations were made by the grading system agreed by the Expert Panel. The recommendations took into account the indications and contraindications of tracheostomy; effect of timing of tracheostomy on incidence of ventilator associated pneumonia, ICU length of stay, ventilator free days & Mortality; comparison of surgical and percutaneous dilatational tracheostomy (PDT) in terms of incidence of complications and cost to the patient; Comparison of various techniques of PDT; Use of fiberoptic bronchoscope and ultrasound in PDT; experience of the operator and qualification; certain special conditions like coagulopathy and morbid obesity. Conclusion: This document presents the first Indian recommendations on tracheostomy in adult critically ill patients based on the practices of the country. These guidelines are expected to improve the safety and extend the indications of tracheostomy in critically ill patients.

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Section: Does the Use Of Fiberoptic Bronchoscope (Fob) While Performimentioning

confidence: 99%

Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations

Gupta¹,

Dixit²,

Choudhry

et al. 2019

Indian Journal of Critical Care Medicine

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“…4 Iatrogenic injury from endotracheal and/or tracheostomy tubes occurs more frequently than other etiologies. 4,7 Studies show endotracheal tube sizes larger than 7.5 place patients at higher risk for tracheal stenosis and posterior glottic stenosis. 8,9 Additionally, comorbidities adversely affecting wound healing, including diabetes, were found to be intrinsic risk factors for glottic stenosis and associated with iatrogenic LTS.…”

Section: Introductionmentioning

confidence: 99%

Laryngotracheal Stenosis: Risk Factors for Tracheostomy Dependence and Dilation Interval

Gadkaree

Pandian

Best

et al. 2016

Otolaryngol.--head neck surg.

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Objective Laryngotracheal stenosis (LTS) is a fibrotic process that narrows the upper airway and has a significant impact on breathing and phonation. Iatrogenic injury from endotracheal and/or tracheostomy tubes is the most common etiology. This study investigates differences in LTS etiologies as they relate to tracheostomy dependence and dilation interval. Study Design Case series with chart review Setting Single-center tertiary care facility Subjects and Methods Review of adult patients with LTS was performed between 2004–2015. The association of patient demographics, comorbidities, disease etiology, and treatment modalities with patient outcomes was assessed. Multiple logistic regression analysis and Kaplan-Meier analysis was performed to determine factors associated with tracheostomy-dependence and time to second procedure respectively. Results 262 patients met inclusion criteria. Iatrogenic patients presented with greater stenosis (p=0.023), greater length (p=0.004), and located further from the vocal folds (p<0.001) compared with other etiologies. Iatrogenic patients were more likely to be African-American and have obstructive sleep apnea, type II diabetes, hypertension, COPD, stroke, and use tobacco. Iatrogenic LTS (OR=3.1, CI= 1.2–8.2), Cotton-Myer Grade 3–4 (OR=2.6, CI=1.1–6.4), and lack of intraoperative steroids (OR=2.9, CI=1.2–6.9) were associated with tracheostomy-dependence. Non-smokers, patients without tracheostomy, and idiopathic LTS patients had a significantly longer time to second dilation procedure. Conclusion Iatrogenic LTS presents with a greater disease burden and higher risk of tracheostomy dependence compared to other etiologies of LTS. Co-morbid conditions promoting microvascular injury, including smoking, COPD, and diabetes, were prevalent in the iatrogenic cohort. Changes in hospital practice patterns to promote earlier tracheostomy in high risk patients could reduce the incidence of LTS.

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“…The cost per procedure with a multiple‐use bronchoscope is difficult to calculate and may vary significantly between institutions since many variables as frequency of uses per device, costs for maintenance, and decontamination influence the overall costs. Nevertheless, it has been estimated to be at least 400€ per use by some institutions . In our institution with a high frequency of use per bronchoscope the costs are lower and are estimated at about 100€ per use which is approximately the price of a VST.…”

Section: Discussionmentioning

confidence: 75%

Feasibility of an endotracheal tube‐mounted camera for percutaneous dilatational tracheostomy

Grensemann

Eichler

Hopf

et al. 2017

Acta Anaesthesiol Scand

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Use of Bronchoscopy in Percutaneous Dilational Tracheostomy

Cited by 39 publications

References 33 publications

Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations

Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations

Laryngotracheal Stenosis: Risk Factors for Tracheostomy Dependence and Dilation Interval

Feasibility of an endotracheal tube‐mounted camera for percutaneous dilatational tracheostomy

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