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Paul AL, Varaham R, Balaraman K, Rajasekaran S, Balasubramani VM. Safety and Feasibility of Very Early Bronchoscopy-assisted Percutaneous Dilatational Tracheostomy in Anterior Cervical Spine Fixation Patients. Indian J Crit Care Med 2022; 26:1086-1090. [PMID: 36876209 PMCID: PMC9983672 DOI: 10.5005/jp-journals-10071-24322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Anterior cervical spine fixation (ACSF) is a common mode of stabilization of cervical spine injuries. These patients usually need a prolonged mechanical ventilation, so an early tracheostomy is beneficial for them. However, it is often delayed due to the close proximity to the surgical site, due to the concerns of infection, and increased bleeding. Percutaneous dilatational tracheostomy (PDT) is also considered a relative contraindication due to the inability to achieve adequate neck extension. Objectives The objectives of our study are to assess the:Feasibility of performing a very early percutaneous dilatational tracheostomy in cervical spine injury patients, post-anterior cervical spine fixation.Safety in doing so with regard to surgical-site infection, early, and late complications.Benefits with regard to outcome measures like ventilator days and length of stay (LOS) in the intensive care unit (ICU) and hospital. Materials and methods We performed a retrospective review of all patients who underwent anterior cervical spine fixation and bedside percutaneous dilatational tracheostomy in our ICU from 1st January 2015 to 31st March 2021. Results Out of the 269 patients admitted to our ICU with cervical spine pathology, 84 were included in the study. About 40.4% patients had injury above C5 level (n-34) and 59.5% had below C5 level. About 86.9% patients had ASIA-A neurology. In our study, percutaneous tracheostomy was done at an average of 2.8 days from the cervical spine fixation. Average length of ventilator days post-tracheostomy was 8.32 days, ICU stay was 10.5 days, and hospital stay was 28.6 days. One patient developed anterior surgical-site infection. Conclusion We conclude from our study that a very early percutaneous dilatational tracheostomy can be done in post-anterior cervical spine fixation patients as early as within 3 days without significant complications. How to cite this article Paul AL, Varaham R, Balaraman K, Rajasekaran S, Balasubramani VM. Safety and Feasibility of Very Early Bronchoscopy-assisted Percutaneous Dilatational Tracheostomy in Anterior Cervical Spine Fixation Patients. Indian J Crit Care Med 2022;26(10):1086-1090.
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Affiliation(s)
- Amrutha Liz Paul
- Department of Critical Care, Ganga Medical Centre & Hospitals, Coimbatore, Tamil Nadu, India
| | - Ram Varaham
- Department of Critical Care, Ganga Medical Centre & Hospitals, Coimbatore, Tamil Nadu, India
| | - Kannan Balaraman
- Department of Oral and Maxillofacial Surgery, Ganga Medical Centre & Hospitals, Coimbatore, Tamil Nadu, India
| | - S Rajasekaran
- Department of Orthopaedics, Ganga Medical Centre & Hospitals, Coimbatore, Tamil Nadu, India
| | - V M Balasubramani
- Department of Critical Care, Ganga Medical Centre & Hospitals, Coimbatore, Tamil Nadu, India
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Ullman J, Karling J, Bark R, Nelson D, Wanecek M, Margolin G. Navigation system for percutaneous tracheotomy. Acta Otolaryngol 2021; 141:953-959. [PMID: 34570658 DOI: 10.1080/00016489.2021.1982147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Percutaneous dilatational tracheotomy (PDT) is a well-established method. The prerequisite is to identify anatomical landmarks of the neck. We introduce a three-dimensional navigation system - SafeTrach. AIMS/OBJECTIVES We present an alternative technique using internal landmarks that can be used in patients with difficult anatomy. MATERIAL AND METHODS The device is a forceps-like instrument with an outer and an inner shank. The later serves as a ventilation lumen and stabilizes the orotracheal tube in the midline of trachea. The outer shank acts as a three-dimensional guide for the puncturing needle. RESULTS Out of 48 patients we have determined the level of puncture in 20 patients by using intraoperative measurements. The distance from the vocal cords to the puncture site was about 50 mm for men and 40 mm for women. In 13 of the patients who had had CT scans, we studied the distance between the vocal cords and the optimal puncture site and found the median distance for men 45 mm and for women 42 mm. CONCLUSIONS AND SIGNIFICANCE With the studied navigation system one may use external or internal landmarks to indicate the puncture level in PDT. The device may minimize the risk of injuring the posterior tracheal wall.
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Affiliation(s)
- Johan Ullman
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Karling
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Rusana Bark
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska institutet, Stockholm, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - David Nelson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Wanecek
- Intensive Care Unit, Capio Saint Göran’s Hospital, Stockholm, Sweden
| | - Gregori Margolin
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska institutet, Stockholm, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
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Gupta VK, Malhotra A, Mamik HK, Latawa A, Kalra G, Gupta S. Percutaneous Dilatational Tracheostomy: Experience of 100 Cases at a Tertiary Care Centre. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02300-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abbott F, Ortega M, Bravo S, Basoalto R, Kattan E. Can we improve teaching and learning of percutaneous dilatational tracheostomy's bronchoscopic guidance? SAGE Open Med 2021; 9:20503121211002321. [PMID: 33796301 PMCID: PMC7983236 DOI: 10.1177/20503121211002321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/14/2022] Open
Abstract
Percutaneous dilatational tracheostomy has become the technique of choice in multiple intensive care units. Among innovations to improve procedural safety and success, bronchoscopic guidance of percutaneous dilatational tracheostomy has been advocated and successfully implemented by multiple groups. Most published literature focuses on the percutaneous dilatational tracheostomy operator, with scarce descriptions of the bronchoscopic particularities of the procedure. In this article, we provide 10 suggestions to enhance specific procedural aspects of bronchoscopic guidance of percutaneous dilatational tracheostomy, and strategies to optimize its teaching and learning, in order to promote learners' competence acquisition and increase patient safety.
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Affiliation(s)
- Francisco Abbott
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
- Departamento de Enfermedades
Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile,
Santiago, Chile
| | - Marcos Ortega
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
- Departamento de Enfermedades
Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile,
Santiago, Chile
| | - Sebastian Bravo
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
| | - Roque Basoalto
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
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Fuente R, Kattan E, Munoz‐Gama J, Puente I, Navarrete M, Kychenthal C, Fuentes R, Bravo S, Galvez V, Sepúlveda M. Development of a comprehensive Percutaneous Dilatational Tracheostomy process model for procedural training: A Delphi-based experts consensus. Acta Anaesthesiol Scand 2021; 65:244-256. [PMID: 32997799 DOI: 10.1111/aas.13716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Deconstructing a complex procedure improves skills learning, but no model has covered all relevant Percutaneous Dilatational Tracheostomy (PDT) procedural aspects. Moreover, the heterogeneity of techniques described may hinder trainees' competency acquisition. Our objective was to develop a PDT model for procedural training that includes a comprehensive step-by-step design. METHODS Procedural descriptions were retrieved after a structured search in medical databases. Activities were extracted and the adherence to McKinley's dimensions of procedural competence was analyzed. We developed a comprehensive PDT model, which was further validated through a Delphi-based consensus of Spanish-speaking international experts. RESULTS The 14 descriptions retrieved for analysis presented a median [interquartile range] of 18 [11-22] steps, covering 3 [2-4] of McKinley's dimensions. The Delphi panel's first model included all McKinley's dimensions, and was answered by 25 experts from nine countries, ending in the second round. The final model included 59 activities divided into six stages (51 from the initial model and eight proposed by experts) and performed by two operators (bronchoscopy and tracheostomy). CONCLUSIONS We have presented a PDT model that includes necessary competence dimensions to be considered complete. The model was validated by an experts' consensus, allowing to improve procedural training to promote safer patient care.
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Affiliation(s)
- Rene Fuente
- División de Anestesiología Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Jorge Munoz‐Gama
- Department of Computer Science School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
| | - Ignacio Puente
- División de Anestesiología Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Matías Navarrete
- Department of Computer Science School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
| | - Catalina Kychenthal
- División de Anestesiología Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Ricardo Fuentes
- División de Anestesiología Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Sebastian Bravo
- Departamento de Medicina Intensiva Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Victor Galvez
- Department of Computer Science School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
| | - Marcos Sepúlveda
- Department of Computer Science School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
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El-Wajeh Y, Varley I, Raithatha A, Glossop A, Smith A, Mohammed-Ali R. Opening Pandora's box: surgical tracheostomy in mechanically ventilated COVID-19 patients. Br J Anaesth 2020; 125:e373-e375. [PMID: 32709307 PMCID: PMC7346799 DOI: 10.1016/j.bja.2020.06.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/29/2020] [Accepted: 06/30/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
| | - Iain Varley
- Department of Oral and Maxillofacial Surgery
| | - Ajay Raithatha
- Department of Anaesthesia, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield UK
| | - Alastair Glossop
- Department of Anaesthesia, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield UK
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Flaherty C. Tracheostomy care: the role of the nurse before, during and after insertion. Nurs Stand 2020; 35:76-82. [PMID: 32657102 DOI: 10.7748/ns.2020.e11500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2019] [Indexed: 01/13/2023]
Abstract
A tracheostomy is a surgical procedure that involves creating an opening and inserting a tube in the trachea to enable air transit from the external atmosphere to the lungs. The insertion of a tracheostomy is a common procedure used to wean patients from mechanical ventilation and to manage patients with upper respiratory tract complications. Furthermore, the coronavirus disease 2019 (COVID-19) pandemic has resulted in many patients requiring a tracheostomy as part of respiratory management. The two most commonly used tracheostomy insertion procedures are the open surgical tracheostomy and the percutaneous dilatation tracheostomy, both of which are associated with a range of complications. This article outlines the indications, benefits and complications of tracheostomy insertion, as well as the various types of tracheostomy tube that may be used. It also explains the role of the nurse in caring for patients before, during and after tracheostomy insertion, including the management of tracheostomy-related complications and emergencies.
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Affiliation(s)
- Cariona Flaherty
- School of Health and Education, Middlesex University, London, England
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Simulation-Based Mastery Learning of Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy. Simul Healthc 2020; 16:157-162. [DOI: 10.1097/sih.0000000000000491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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AYDIN G, YAZICI İ. Can biochemical biomarkers predict mortality in percutaneous dilatational tracheostomies? JOURNAL OF HEALTH SCIENCES AND MEDICINE 2020. [DOI: 10.32322/jhsm.668108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Design and Evaluation of a Low-Cost Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy Simulator. Simul Healthc 2020; 14:415-419. [PMID: 31804426 PMCID: PMC6903325 DOI: 10.1097/sih.0000000000000399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Supplemental digital content is available in the text. Introduction Bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT) is an invasive procedure regularly performed in the intensive care unit. Risk of serious complications have been estimated in up to 5%, focused during the learning phase. We have not found any published formal training protocols, and commercial simulators are costly and not widely available in some countries. The objective of this study was to present the design and simulator performance of a low-cost BG-PDT simulator. Methods A simulator was designed with materials available in a hardware store, synthetic skin pads, ex vivo bovine tracheas, and a pipe inspection camera. The simulator was tested in 8 experts and 9 novices. Sessions were video recorded, and participants were equipped with the Imperial College Surgical Device, a hand motion–tracking device. Performance was evaluated with a multimodal approach, including first attempt success rate, global success rate, total procedural time, Imperial College Surgical Device–derived proficiency parameters, and global rating scale applied blindly by 2 expert observers. A satisfaction survey was applied after the procedure. Results A simulator was successfully constructed, allowing multiple iterations per assembly, with a fixed cost of US $30 and $4 per use. Experts had greater global and first attempt success rate, performed the procedure faster, and with greater proficiency. It presented high user satisfaction and fidelity. Conclusions A low-cost BG-PDT simulator was successfully constructed, with the ability to discriminate between experts and novices, and with high fidelity. Considering its ease of construction and cost, it can be replicated in almost any intensive care unit.
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Hodgson RE, Pillay TK. Awake percutaneous tracheostomy as an alternative to open emergency tracheostomy in a threatened airway. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2017. [DOI: 10.1080/22201181.2017.1371916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- RE Hodgson
- Department of Anaesthesia, Inkosi Albert Luthuli Central Hospital, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, eThekwini-Durban, South Africa
| | - TK Pillay
- Department of Anaesthesia, Inkosi Albert Luthuli Central Hospital, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, eThekwini-Durban, South Africa
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12
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Al-Attar A. Single-use bronchoscopes for percutaneous dilational tracheostomy on the ICU. Br J Anaesth 2016. [DOI: 10.1093/bja/el_13923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ullman J, Karling J, Margolin G. A new safe and cost-effective percutaneous dilatational tracheotomy: SafeTrach. Acta Otolaryngol 2016; 136:598-605. [PMID: 26902954 DOI: 10.3109/00016489.2016.1139746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Conclusion SafeTrach is a new simplified and safe technique to perform percutaneous dilatational tracheotomy (PDT) that eliminates known risk factors compared with existing percutaneous techniques. In the present clinical study, also patients with disadvantageous anatomy not suitable for conventional PDT (CPDT) were treated without complications using SafeTrach. PDT with SafeTrach (STPDT) offers an excellent solution for patients who need tracheotomy in connection with elective ear, nose, and throat (ENT) surgery. Objectives To assess a new technique for percutaneous tracheotomy. Methods Seventeen patients were tracheotomized with STPDT using SafeTrach for the initial penetration sequence and single step dilatational techniques for the dilatational sequence. The patients represented a variety of different neck anatomies. Fifteen patients were head- and neck cancer patients that were subjects of free flap transplants. Results This study showed that STPDT was safe and easy to perform and time-efficient. The median duration of the procedure was 11.5 min and the puncture was in all cases located in the midline of the trachea either between the 2nd and 3rd tracheal ring (n = 13) or between the 3rd and 4th ring (n = 4).
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Affiliation(s)
- Johan Ullman
- Department of Anesthesiology and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Karling
- ENT Department, Karolinska University Hospital, Stockholm, Sweden
| | - Gregori Margolin
- Department of Otolaryngology and Head & Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
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