Temporary Tracheostomy

Respiratory Emergencies

Respiratory distress is commonly seen in dogs and cats presenting to the emergency room. Rapid identification of respiratory difficulty with strategic stabilization and diagnostic efforts are warranted to maximize patient outcome. This article focuses on the relevant anatomy and physiology of the respiratory system and the clinical recognition, stabilization, and initial diagnostic planning for small animal patients that present for respiratory emergencies.

A pilot study evaluating the utility of a novel tube cricothyrotomy technique in providing ventilation in small animals using a live porcine model

Background

Tube cricothyrotomy has been suggested as a first-choice for emergency surgical airway access in small animals, rather than the more commonly accepted procedures of tracheotomy and needle cricothyrotomy.

Methods

A small pilot study of tube cricothyrotomy in a live porcine model was conducted to evaluate this method. The technique was modified to permit the use of commonly available equipment and ease of application. Following ethics approval, a tube cricothyrotomy was performed on 9 live pigs. The endpoints were the efficacy of ventilation through the tube as measured by end-tidal carbon dioxide, successful placement of the tube and the time taken for placement.

Results

Of the nine pigs, eight had a tube placed successfully, with the median procedure time being 111.5 seconds (range: 35–240 seconds). After 10 mins, the mean end-tidal carbon dioxide was 58.3 mmHg (95% CI: 55.2–61.3 mmHg), with a range of 54–64 mmHg. Tube cricothyrotomy holds promise as a means of rapidly obtaining tracheal access in small animals and temporarily sustaining ventilation in an emergency.

Conclusion

Further detailed investigation is warranted to assess the use of this technique in the small animal emergency setting.

A modified temporary tracheostomy in dogs: outcome and complications in 21 dogs (2012 to 2017)

OBJECTIVES

To describe a modified temporary tracheostomy that included placing a Penrose drain sling dorsal to the trachea. To report outcomes and complications in brachycephalic versus non-brachycephalic breeds.

MATERIALS AND METHODS

Retrospective review of signalment, diagnosis, outcome, complications and management of dogs that underwent modified temporary tracheostomy.

RESULTS

Twenty-one dogs were included. Tracheostomy tubes were maintained for periods ranging from 1 to 21 days (median 4 days). There were no intraoperative complications or complications related to the placement of the Penrose drain. Postoperative complications occurred in eight dogs, including dislodgement of the tracheostomy tube (n=6), obstruction of the tracheostomy tube (n=1), subcutaneous emphysema and pneumomediastinum (n=1). Twenty dogs survived until discharge; one was euthanised due to persistence of primary disease. The complication rate in brachycephalic breeds and non-brachycephalic was 37∙5 and 40%, respectively. Tube dwell duration of 4 days or longer was associated with a higher complication rate.

CLINICAL SIGNIFICANCE

The modified temporary tracheostomy appears to simplify tracheostomy care, improve tracheostomy outcome and reduce tube-associated mortality compared with standard tracheostomy. In this study, brachycephalic dogs did not have a higher complication rate than non-brachycephalic dogs.