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Bódis F, Orosz G, Tóth JT, Szabó M, Élő LG, Gál J, Élő G. Percutaneous tracheostomy: Comparison of three different methods with respect to tracheal cartilage injury in cadavers—Randomized controlled study. Pathol Oncol Res 2023; 29:1610934. [PMID: 37123534 PMCID: PMC10135429 DOI: 10.3389/pore.2023.1610934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023]
Abstract
Background: Performing tracheostomy improves patient comfort and success rate of weaning from prolonged invasive mechanical ventilation. Data suggest that patients have more benefit of percutaneous technique than the surgical procedure, however, there is no consensus on the percutaneous method of choice regarding severe complications such as late tracheal stenosis. Aim of this study was comparing incidences of cartilage injury caused by different percutaneous dilatation techniques (PDT), including Single Dilator, Griggs’ and modified (bidirectional) Griggs’ method.Materials and methods: Randomized observational study was conducted on 150 cadavers underwent post-mortem percutaneous tracheostomy. Data of cadavers including age, gender and time elapsed from death until the intervention (more or less than 72 h) were collected and recorded. Primary and secondary outcomes were: rate of cartilage injury and cannula malposition respectively.Results: Statistical analysis revealed that method of intervention was significantly associated with occurrence of cartilage injury, as comparing either standard Griggs’ with Single Dilator (p = 0.002; OR: 4.903; 95% CI: 1.834–13.105) or modified Griggs’ with Single Dilator (p < 0.001; OR: 6.559; 95% CI: 2.472–17.404), however, no statistical difference was observed between standard and modified Griggs’ techniques (p = 0.583; OR: 0.748; 95% CI: 0.347–1.610). We found no statistical difference in the occurrence of cartilage injury between the early- and late post-mortem group (p = 0.630). Neither gender (p = 0.913), nor age (p = 0.529) influenced the rate of cartilage fracture. There was no statistical difference between the applied PDT techniques regarding the cannula misplacement/malposition.Conclusion: In this cadaver study both standard and modified Griggs’ forceps dilatational methods were safer than Single dilator in respect of cartilage injury.
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Affiliation(s)
- Fruzsina Bódis
- Department of Otorhinolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary
- *Correspondence: Fruzsina Bódis,
| | - Gábor Orosz
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - József T. Tóth
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Marcell Szabó
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - László Gergely Élő
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - János Gál
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Gábor Élő
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
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Gupta S, Dixit S, Choudhry D, Govil D, Mishra RC, Samavedam S, Zirpe K, Srinivasan S, Mohamed Z, Gupta KV, Wanchoo J, Chakrabortty N, Gurav S. Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations. Indian J Crit Care Med 2020; 24:S31-S42. [PMID: 32205955 PMCID: PMC7085814 DOI: 10.5005/jp-journals-10071-g23184] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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. HOW TO CITE THIS ARTICLE Gupta S, Dixit S, Choudhry D, Govil D, Mishra RC, Samavedam S, Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations. Indian J Crit Care Med 2020;24(Suppl 1):S31-S42.
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Affiliation(s)
- Sachin Gupta
- Department of Critical Care Medicine, Narayana Superspeciality Hospital, Gurugram, Haryana, India, , e-mail:
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan & MJM Hospital, Pune, Maharashtra, India, , e-mail:
| | - Dhruva Choudhry
- Department of Pulmonary & Critical Care Medicine, University of Health Sciences Rohtak, Haryana, India, , e-mail:
| | - Deepak Govil
- Department of Critical Care, Institute of Critical Care & Anesthesiology, Medanta The Medicity, Gurugram, Haryana, India, , e-mail:
| | | | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Kapil Zirpe
- Department of Neurocritical Care, Ruby Hall Clinic, Grant Medical Foundation, Pune, Maharashtra, India, , e-mail:
| | - Shrikanth Srinivasan
- Department of Critical Care Medicine, Manipal Hospitals, New Delhi, India, , e-mail:
| | - Zubair Mohamed
- Department of Organ Transplant Anaesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India, , e-mail:
| | - Kv Venkatesha Gupta
- Department of Critical Care Medicine, Manipal Hospitals, Bengaluru, Karnataka, India, , e-mail:
| | - Jaya Wanchoo
- Department of Neuroanaesthesia and Critical Care, Institute of Neurosciences, Medanta The Medicity, Gurugram, Haryana, India, , e-mail:
| | - Nilanchal Chakrabortty
- Department of Neurointensive Care, Institute of Neurosciences, Kolkata, West Bengal, India, , e-mail:
| | - Sushma Gurav
- Department of Neurocritical Care, Ruby Hall Clinic, Grant Medical Foundation, Pune, Maharashtra, India, , e-mail:
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A Modified Translaryngeal Tracheostomy Technique in the Neurointensive Care Unit. Rationale and Single-center Experience on 199 Acute Brain-damaged Patients. J Neurosurg Anesthesiol 2019; 31:330-336. [PMID: 30161098 DOI: 10.1097/ana.0000000000000535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Brain-injured patients frequently require tracheostomy, but no technique has been shown to be the gold standard for these patients. We developed and introduced into standard clinical practice an innovative bedside translaryngeal tracheostomy (TLT) technique aided by suspension laryngoscopy (modified TLT). During this procedure, the endotracheal tube is left in place until the airway is secured with the new tracheostomy. This study assessed the clinical impact of this technique in brain-injured patients. MATERIALS AND METHODS This is a retrospective analysis of prospectively collected data from adult brain-injured patients who had undergone modified TLT during the period spanning from January 2010 to December 2016 at the Neurointensive care unit, San Gerardo Hospital (Monza, Italy). The incidence of intraprocedural complications, including episodes of intracranial hypertension (intracranial pressure [ICP] >20 mm Hg), was documented. Neurological, ventilatory, and hemodynamic parameters were retrieved before, during, and after the procedure. Risk factors for complications and intracranial hypertension were assessed by univariate logistic analysis. Data are presented as n (%) and median (interquartile range) for categorical and continuous variables, respectively. RESULTS A total of 199 consecutive brain-injured patients receiving modified TLT were included. An overall 52% male individuals who were 66 (54 to 74) years old and who had an admission Glasgow Coma Scale of 7 (6 to 10) were included in the cohort. Intracerebral hemorrhage (30%) was the most frequent diagnosis. Neurointensivists performed 130 (65%) of the procedures. Patients underwent tracheostomy 10 (7 to 13) days after intensive care unit admission. Short (ie, <2 min) and clinically uneventful increases in ICP>20 mm Hg were observed in 11 cases. Overall, the procedure was associated with an increase in ICP from 7 (4 to 10) to 12 (7 to 18) mm Hg (P<0.001). Compared with baseline, cerebral perfusion pressure (CPP), respiratory variables, and hemodynamics were unchanged during the procedure (P-value, not significant). Higher baseline ICP and core temperature were associated with an increased risk of complications and intracranial hypertension. Complication rates were low: 1 procedure had to be converted to a surgical tracheostomy, and 1 (0.5%) episode of minor bleeding and 5 (2.5%) of minor non-neurological complications were recorded. Procedures performed by intensivists did not have a higher risk of complications compared with those performed by ear, nose, and throat specialists. CONCLUSIONS A modified TLT (by means of suspension laryngoscopy) performed by neurointensivists is feasible in brain-injured patients and does not adversely impact ICP and CPP.
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Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, Constantin JM, Demoule A, Diehl JL, Guinot PG, Jegoux F, L’Her E, Luyt CE, Mahjoub Y, Mayaux J, Quintard H, Ravat F, Vergez S, Amour J, Guillot M. Trachéotomie en réanimation : recommandations formalisées d’experts sous l’égide de la Société de réanimation de langue française (SRLF) et de la Société française d’anesthésie et de réanimation (SFAR), en collaboration avec la Société française de médecine d’urgence (SFMU) et la Société française d’otorhinolaryngologie (SFORL). MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2018-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, Constantin JM, Demoule A, Diehl JL, Guinot PG, Jegoux F, L’Her E, Luyt CE, Mahjoub Y, Mayaux J, Quintard H, Ravat F, Vergez S, Amour J, Guillot M. Trachéotomie en réanimation. ANESTHÉSIE & RÉANIMATION 2018. [DOI: 10.1016/j.anrea.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, Constantin JM, Demoule A, Diehl JL, Guinot PG, Jegoux F, L'Her E, Luyt CE, Mahjoub Y, Mayaux J, Quintard H, Ravat F, Vergez S, Amour J, Guillot M. Tracheotomy in the intensive care unit: Guidelines from a French expert panel: The French Intensive Care Society and the French Society of Anaesthesia and Intensive Care Medicine. Anaesth Crit Care Pain Med 2018; 37:281-294. [PMID: 29559211 DOI: 10.1016/j.accpm.2018.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the grading of recommendations assessment, development and evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de réanimation de langue française) and the French Society of Anesthesia and Intensive Care Medicine (Société francaise d'anesthésie réanimation) with the participation of the French Emergency Medicine Association (Société française de médecine d'urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1±) and 6 a low level of proof (Grade 2±). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced.
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Affiliation(s)
- Jean-Louis Trouillet
- Service de réanimation, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Olivier Collange
- Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, pôle d'anesthésie-réanimation chirurgicale, SAMU, SMUR, NHC, 1, place de l'Hôpital, 67000 Strasbourg, France; EA 3072, FMTS université de Strasbourg, 67000 Strasbourg, France.
| | - Fouad Belafia
- Inserm, U1046, intensive care unit and department of anesthesiology, research unit, university of Montpellier, Saint-Éloi hospital, Montpellier school of medicine, 34000 Montpellier, France
| | - François Blot
- Medical-surgical intensive care unit, Gustave-Roussy Cancer Campus, 94800 Villejuif, France
| | - Gilles Capellier
- EA3920, université de Franche-Comté, CHRU de Besançon, 25000 Besançon, France; Australian and New Zealand intensive care research centre, department of epidemiology and preventive medicine, Monash University Clayton, Australia
| | - Eric Cesareo
- SAMU de Lyon and department of emergency medicine, Hospices Civils de Lyon, Edouard-Herriot hospital, 69003 Lyon, France; Lyon Sud, school of medicine, university Lyon 1, 69600 Oullins, France
| | - Jean-Michel Constantin
- Department of preoperative medicine university hospital of Clermont-Ferrand, 63000 Clermont-Ferrand, France; EA-7281, R2D2, Auvergne University, 63000 Clermont-Ferrand, France
| | - Alexandre Demoule
- Inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique Sorbonne Université, 75013 Paris France; AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service de pneumologie et réanimation médicale du département R3S, Sorbonne Université Paris, 75013 Paris, France
| | - Jean-Luc Diehl
- Medical ICU, Georges-Pompidou European Hospital, AP-HP, 75016 Paris, France; Inserm UMR-S1140 Paris Descartes University and Sorbonne Paris Cité, 75006 Paris, France
| | - Pierre-Grégoire Guinot
- Anaesthesiology and critical care department, Amiens University Hospital, place Victor-Pauchet, 80054 Amiens, France; Inserm, U1088, Jules-Verne University of Picardy, 80054 Amiens, France
| | - Franck Jegoux
- Service ORL et chirurgie cervico-maxillofaciale, CHU de Pontchaillou, rue H.-Le-Guilloux, 35033 Rennes cedex 9, France
| | - Erwan L'Her
- CeSim/LaTIM Inserm, UMR 1101, université de Bretagne Occidentale, rue Camille-Desmoulins, 29200 Brest cedex, France; Médecine intensive et réanimation CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest cedex, France
| | - Charles-Edouard Luyt
- Service de réanimation, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France; Inserm, UMRS-1166, UPMC, université Paris 06, ICAN, institute of cardiometabolism and nutrition sorbonne universités, 75013 Paris, France
| | - Yazine Mahjoub
- Department of anesthesia and intensive care, Amiens-Picardie, university Hospital, 80054 Amiens, France
| | - Julien Mayaux
- Inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique Sorbonne Université, 75013 Paris France; AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service de pneumologie et réanimation médicale du département R3S, Sorbonne Université Paris, 75013 Paris, France
| | - Hervé Quintard
- Réanimation médico-chirurgicale, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France; CNRS, UMR 7275, IPMC, 06560 Sophia Antipolis Valbonne, France
| | - François Ravat
- Centre des brûlés, centre hospitalier St-Joseph et St-Luc, 20, quai Claude-Bernard, 69007 Lyon, France
| | - Sébastien Vergez
- ORL chirurgie cervicofaciale, CHU de Toulouse, Rangueil-Larrey, 24, chemin de Pouvourville, 31059 Toulouse cedex 9, France
| | - Julien Amour
- Département d'anesthésie et de réanimation chirurgicale, institut de cardiologie, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Max Guillot
- EA 3072, FMTS université de Strasbourg, 67000 Strasbourg, France; Hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, réanimation médicale, avenue Molière, 67200 Strasbourg, France.
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7
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Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, Constantin JM, Demoule A, Diehl JL, Guinot PG, Jegoux F, L'Her E, Luyt CE, Mahjoub Y, Mayaux J, Quintard H, Ravat F, Vergez S, Amour J, Guillot M. Tracheotomy in the intensive care unit: guidelines from a French expert panel. Ann Intensive Care 2018; 8:37. [PMID: 29546588 PMCID: PMC5854567 DOI: 10.1186/s13613-018-0381-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/08/2018] [Indexed: 12/29/2022] Open
Abstract
Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d'Anesthésie Réanimation) with the participation of the French Emergency Medicine Association (Société Française de Médecine d'Urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1+/-) and 6 a low level of proof (Grade 2+/-). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced.
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Affiliation(s)
- Jean Louis Trouillet
- Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Collange
- Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Pôle d'Anesthésie-Réanimation Chirurgicale, SAMU, SMUR, NHC, 1 Place de l'Hôpital, 67000, Strasbourg, France.,EA 3072, FMTS, Université de Strasbourg, Strasbourg, France
| | - Fouad Belafia
- Intensive Care Unit and Department of Anesthesiology, Research Unit INSERM U1046, University of Montpellier Saint Eloi Hospital and Montpellier School of Medicine, Montpellier, France
| | - François Blot
- Medical-Surgical Intensive Care Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Gilles Capellier
- CHRU Besançon 25000, EA3920 Université de Franche-Comté, Besançon, France.,Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia
| | - Eric Cesareo
- SAMU de Lyon and Department of Emergency Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.,Lyon Sud School of Medicine, University Lyon 1, Oullins, France
| | - Jean-Michel Constantin
- Department of Preoperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.,R2D2, EA-7281, Auvergne University, Clermont-Ferrand, France
| | - Alexandre Demoule
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Sorbonne Université, Paris, France
| | - Jean-Luc Diehl
- Medical ICU, AP-HP, Georges Pompidou European Hospital, Paris, France.,INSERM UMR-S1140, Paris Descartes University and Sorbonne Paris Cité, Paris, France
| | - Pierre-Grégoire Guinot
- Anaesthesiology and Critical Care Department, Amiens University Hospital, Place Victor Pauchet, 80054, Amiens, France.,INSERM U1088, Jules Verne University of Picardy, 80054, Amiens, France
| | - Franck Jegoux
- Service ORL et Chirurgie Cervico-maxillo-Faciale, CHU PONTCHAILLOU, Rue H. Le Guilloux, 35033, Rennes Cedex 9, France
| | - Erwan L'Her
- CeSim/LaTIM INSERM UMR 1101, Université de Bretagne Occidentale, Rue Camille Desmoulins, 29200, Brest Cedex, France.,Médecine Intensive et Réanimation, CHRU de Brest, Boulevard Tanguy Prigent, 29200, Brest Cedex, France
| | - Charles-Edouard Luyt
- Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,UPMC Université Paris 06, INSERM, UMRS-1166, ICAN Institute of Cardiometabolism and Nutrition, Sorbonne Universités, Paris, France
| | - Yazine Mahjoub
- Department of Anesthesia and Intensive Care, Amiens-Picardie University Hospital, Amiens, France
| | - Julien Mayaux
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Sorbonne Université, Paris, France
| | - Hervé Quintard
- Réanimation médico chirurgicale Hôpital Pasteur 2 CHU de Nice, 30 voie romaine, 06000, Nice, France.,CNRS UMR 7275, IPMC Sophia Antipolis, Valbonne, France
| | - François Ravat
- Centre des brûlés, Centre Hospitalier St Joseph et St Luc, 20 quai Claude Bernard, 69007, Lyon, France
| | - Sebastien Vergez
- ORL Chirurgie Cervicofaciale, CHU Toulouse Rangueil-Larrey, 24 chemin de Pouvourville, 31059, Toulouse Cedex 9, France
| | - Julien Amour
- Département d'Anesthésie et de Réanimation Chirurgicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Max Guillot
- EA 3072, FMTS, Université de Strasbourg, Strasbourg, France. .,Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Réanimation Médicale, Avenue Molière, 67200, Strasbourg, France.
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8
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Raimondi N, Vial MR, Calleja J, Quintero A, Cortés Alban A, Celis E, Pacheco C, Ugarte S, Añón JM, Hernández G, Vidal E, Chiappero G, Ríos F, Castilleja F, Matos A, Rodriguez E, Antoniazzi P, Teles JM, Dueñas C, Sinclair J, Martínez L, Von der Osten I, Vergara J, Jiménez E, Arroyo M, Rodriguez C, Torres J, Fernandez-Bussy S, Nates JL. Evidence-based guides in tracheostomy use in critical patients. Med Intensiva 2017; 41:94-115. [PMID: 28188061 DOI: 10.1016/j.medin.2016.12.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/20/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. CONCLUSION Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.
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Affiliation(s)
- N Raimondi
- Hospital Municipal Juan A. Fernández, Universidad de Buenos Aires, Argentina
| | - M R Vial
- MD Anderson Cancer Center, The University of Texas, Texas, United States; Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - J Calleja
- Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, Nuevo León, México
| | - A Quintero
- Instituto Medico de Alta Tecnología, Universidad del Sinú, Montería, Colombia
| | - A Cortés Alban
- Clínica Mayor de Temuco, Hospital de Nueva Imperial, Universidad Mayor de Temuco, Temuco, Chile
| | - E Celis
- Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | - C Pacheco
- Hospital Universitario de Caracas, Caracas, Venezuela
| | - S Ugarte
- Hospital del Salvador, Clínica Indisa, Universidad de Chile, Santiago, Chile
| | - J M Añón
- Hospital Universitario la Paz -Carlos III. IdiPaz, Madrid, España
| | - G Hernández
- Complejo Hospitalario de Toledo, Toledo, España
| | - E Vidal
- Hospital Ángeles Lomas, Hospital Español de México, Ciudad de México, México
| | - G Chiappero
- Hospital Juan A. Fernández CABA, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - F Ríos
- Hospital Nacional Alejandro Posadas, Sanatorio Las Lomas, San Isidro, Buenos Aires, Argentina
| | - F Castilleja
- Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, Nuevo León, México
| | - A Matos
- Complejo Hospitalario Caja de Seguro Social, Panamá
| | - E Rodriguez
- Complejo Hospitalario Caja de Seguro Social, Panamá
| | - P Antoniazzi
- Hospital Santa Casa, Ribeirao Preto, Sao Paulo, Brazil
| | - J M Teles
- Hospital de Urgências de Goiânia, Goiás, Brazil
| | - C Dueñas
- Gestión Salud, Santa Cruz de Bocagrande, Universidad de Cartagena, Cartagena, Colombia
| | - J Sinclair
- Hospital Punta Pacífica, Johns Hopkins Medicine, Universidad de Panamá, Ciudad de Panamá, Panamá
| | - L Martínez
- Hospital Policlínica Metropolitana, Caracas, Venezuela
| | - I Von der Osten
- Hospital Central "Miguel Pérez Carreño" IVSS, Universidad Central de Venezuela, Caracas, Venezuela
| | - J Vergara
- Hospital Luis Vernaza, Universidad de Especialidades Espíritu Santo "UEES", Guayaquil, Ecuador
| | - E Jiménez
- Baylor Scott & White Health, Texas A&M Health Science Center College of Medicine, Temple, Texas, Estados Unidos
| | - M Arroyo
- Clínica Santa Sofía, Caracas, Venezuela
| | - C Rodriguez
- Instituto Medico de Alta Tecnología, Universidad del Sinú, Montería, Colombia
| | - J Torres
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - S Fernandez-Bussy
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile; Division of Pulmonary, Critical Care & Sleep Medicine, University of Florida, Gainesville, Florida, Estados Unidos
| | - J L Nates
- MD Anderson Cancer Center, The University of Texas, Texas, United States.
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9
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Raimondi N, Vial MR, Calleja J, Quintero A, Cortés A, Celis E, Pacheco C, Ugarte S, Añón JM, Hernández G, Vidal E, Chiappero G, Ríos F, Castilleja F, Matos A, Rodriguez E, Antoniazzi P, Teles JM, Dueñas C, Sinclair J, Martínez L, von der Osten I, Vergara J, Jiménez E, Arroyo M, Rodríguez C, Torres J, Fernandez-Bussy S, Nates JL. Evidence-based guidelines for the use of tracheostomy in critically ill patients. J Crit Care 2016; 38:304-318. [PMID: 28103536 DOI: 10.1016/j.jcrc.2016.10.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To provide evidence-based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS A taskforce composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified, of which 226 publications were chosen. The taskforce generated a total of 19 recommendations, 10 positive (1B, 3; 2C, 3; 2D, 4) and 9 negative (1B, 8; 2C, 1). A recommendation was not possible in 6 questions. CONCLUSIONS Percutaneous techniques are associated with a lower risk of infections compared with surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.
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Affiliation(s)
- Néstor Raimondi
- Hospital Municipal Juan A. Fernández, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Macarena R Vial
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA; Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - José Calleja
- Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, México
| | - Agamenón Quintero
- Instituto Médico de Alta Tecnología, Universidad del Sinú, Montería, Córdoba, Colombia
| | - Albán Cortés
- Clínica Mayor de Temuco, Hospital de Nueva Imperial, Universidad Mayor de Temuco, Temuco, Chile
| | - Edgar Celis
- Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | - Clara Pacheco
- Hospital Universitario de Caracas, Caracas, Venezuela
| | - Sebastián Ugarte
- Hospital del Salvador, Clínica Indisa, Universidad de Chile, Santiago, Chile
| | - José M Añón
- Hospital Universitario La Paz-Carlos III. IdiPaz, Madrid, Spain
| | | | - Erick Vidal
- Hospital Ángeles Lomas, Hospital Español de México, Ciudad de México, México
| | - Guillermo Chiappero
- Hospital Juan A. Fernández CABA, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Fernando Ríos
- Hospital Nacional Alejandro Posadas, Sanatorio Las Lomas, San Isidro, Buenos Aires, Argentina
| | - Fernando Castilleja
- Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, México
| | - Alfredo Matos
- Complejo Hospitalario Caja de Seguro Social, Ciudad de Panamá, Panamá
| | - Enith Rodriguez
- Complejo Hospitalario Caja de Seguro Social, Ciudad de Panamá, Panamá
| | - Paulo Antoniazzi
- Hospital Santa Casa de Ribeirão Preto, Centro Universitário Barao de Maua, São Paulo, Brazil
| | | | - Carmelo Dueñas
- Gestión Salud, Santa Cruz de Bocagrande, Universidad de Cartagena, Cartagena, Colombia
| | - Jorge Sinclair
- Hospital Punta Pacífica, Johns Hopkins Medicine, Universidad de Panamá, Ciudad de Panamá, Panamá
| | | | - Ingrid von der Osten
- Hospital Central "Miguel Pérez Carreño" IVSS, Universidad Central de Venezuela, Caracas, Venezuela
| | - José Vergara
- Hospital Luis Vernaza, Universidad de Especialidades Espíritu Santo "UEES,", Guayaquil, Ecuador
| | - Edgar Jiménez
- Baylor Scott & White Health, Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| | | | - Camilo Rodríguez
- Instituto Médico de Alta Tecnología, Universidad del Sinú, Montería, Córdoba, Colombia
| | - Javier Torres
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Sebastián Fernandez-Bussy
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile; Division of Pulmonary, Critical Care & Sleep Medicine, University of Florida, Gainesville, FL
| | - Joseph L Nates
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.
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10
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Abstract
OBJECTIVES The prevalence and impact of longer-term outcomes following percutaneous tracheostomy, particularly tracheal stenosis, are unclear. Previous meta-analyses addressing this problem have been confounded by the low prevalence of tracheal stenosis and a limited number of studies. DESIGN Embase, PubMed-Medline, and the Cochrane Central Register of Clinical Trials were searched to identify all prospective studies of tracheostomy insertion in the critically ill. To reflect contemporary practice, the search was limited to studies published from 2000 onward. We scrutinized the bibliographies of returned studies for additional articles. Meta-analyses were undertaken to estimate the pooled risk difference of tracheal stenosis, bleeding, and wound infection comparing different techniques. MEASUREMENTS AND MAIN RESULTS We identified a total of 463 studies, 29 (5,473 patients) of which met the inclusion criteria. Nine were randomized controlled trials, six were nonrandomized comparative studies, and 14 were single-arm cohort studies. Risk of wound infection was greater for the surgical tracheostomy than for the Ciaglia multiple dilator technique, pooled risk difference 0.12 (95% CI, 0.02-0.23). We did not identify significant risk differences in other meta-analyses. Pooling across all studies according to the random-effects proportion meta-analysis suggests a higher prevalence of tracheal stenosis, wound infection, and major bleeding for surgical tracheostomies. CONCLUSIONS Considering comparative data, there was no significant difference in the prevalence of tracheal stenosis or major bleeding between percutaneous and surgical tracheostomy. In relation to wound infection, we have found a reduction associated with the original Ciaglia technique when compared with that with the surgical tracheostomy. Considering all published data reporting long-term outcomes pooled proportion meta-analysis indicates a trend toward a higher rate of tracheal stenosis and an increased risk of major bleeding and wound infection for surgical tracheostomies. This finding may be biased as a result of targeted patient selection, and further, high-quality long-term comparative data are needed to confirm these findings.
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11
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Akulian JA, Yarmus L, Feller-Kopman D. The role of cricothyrotomy, tracheostomy, and percutaneous tracheostomy in airway management. Anesthesiol Clin 2016; 33:357-67. [PMID: 25999008 DOI: 10.1016/j.anclin.2015.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cricothyrotomy, percutaneous dilation tracheostomy, and surgical tracheostomy are cost-effective and safe techniques employed in the management of critically ill patients requiring insertion of an artificial airway. These procedures have been well characterized and studied in the surgical, emergency medicine, and critical care literature. This article focuses on the role of each of these modalities in airway management, specifically comparing the data for each procedure in regard to procedural outcomes. The authors discuss the techniques available and the relevant background data regarding choice of each method and its integration into clinical practice.
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Affiliation(s)
- Jason A Akulian
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, 8007 Burnett Womack, CB 7219, Chapel Hill, NC 27599-7219, USA
| | - Lonny Yarmus
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, Johns Hopkins Hospital, Johns Hopkins University, 1800 Orleans Street, Suite 7125, Baltimore, MD 21287, USA
| | - David Feller-Kopman
- Bronchoscopy and Interventional Pulmonology, Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD 21287, USA.
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12
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Putensen C, Theuerkauf N, Guenther U, Vargas M, Pelosi P. Percutaneous and surgical tracheostomy in critically ill adult patients: a meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:544. [PMID: 25526983 PMCID: PMC4293819 DOI: 10.1186/s13054-014-0544-7] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 09/11/2014] [Indexed: 12/11/2022]
Abstract
Introduction The aim of this study was to conduct a meta-analysis to determine whether percutaneous tracheostomy (PT) techniques are advantageous over surgical tracheostomy (ST), and if one PT technique is superior to the others. Methods Computerized databases (1966 to 2013) were searched for randomized controlled trials (RCTs) reporting complications as predefined endpoints and comparing PT and ST and among the different PT techniques in mechanically ventilated adult critically ill patients. Odds ratios (OR) and mean differences (MD) with 95% confidence interval (CI), and I2 values were estimated. Results Fourteen RCTs tested PT techniques versus ST in 973 patients. PT techniques were performed faster (MD, −13.06 minutes (95% CI, −19.37 to −6.76 (P <0.0001)); I2 = 97% (P <0.00001)) and reduced odds for stoma inflammation (OR, 0.38 (95% CI, 0.19 to 0.76 (P = 0.006)); I2 = 2% (P = 0.36)), and infection (OR, 0.22 (95% CI, 0.11 to 0.41 (P <0.00001)); I2 = 0% (P = 0.54)), but increased odds for procedural technical difficulties (OR, 4.58 (95% CI, 2.21 to 9.47 (P <0.0001)); I2 = 0% (P = 0.63)). PT techniques reduced odds for postprocedural major bleeding (OR, 0.39 (95% CI, 0.15 to 0.97 (P = 0.04)); I2 = 0% (P = 0.69)), but not when a single RCT using translaryngeal tracheostomy was excluded (OR, 0.58 (95% CI, 0.21 to 1.63 (P = 0.30)); I2 = 0% (P = 0.89)). Eight RCTs compared different PT techniques in 700 patients. Multiple (MDT) and single step (SSDT) dilatator techniques are associated with the lowest odds for difficult dilatation or cannula insertion (OR, 0.30 (95% CI, 0.12 to 0.80 (P = 0.02)); I2 = 56% (P = 0.03)) and major intraprocedural bleeding (OR, 0.29 (95% CI, 0.10 to 0.85 (P = 0.02)); I2 = 0% (P = 0.72)), compared to the guide wire dilatation forceps technique. Conclusion In critically ill adult patients, PT techniques can be performed faster and reduce stoma inflammation and infection but are associated with increased technical difficulties when compared to ST. Among PT techniques, MDT and SSDT were associated with the lowest intraprocedural risks and seem to be preferable. Electronic supplementary material The online version of this article (doi:10.1186/s13054-014-0544-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany.
| | - Nils Theuerkauf
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany.
| | - Ulf Guenther
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany.
| | - Maria Vargas
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Largo Rosanna Benzi 8, 16132, Geneva, Italy.
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Largo Rosanna Benzi 8, 16132, Geneva, Italy.
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13
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Gill S, Low WY, Coggon JM, Slaney K, Stewart P, Norton A, Beed M, Gardiner D. Tracheostomy on the Intensive Care Unit – A Two-Month Network-Wide Snapshot. J Intensive Care Soc 2014. [DOI: 10.1177/175114371401500202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tracheostomy is a common and invasive procedure performed on the intensive care unit and has significant associated complications. Current evidence is insufficient to clearly guide practice. We conducted a two-month prospective service evaluation of tracheostomy within our local critical care network. We found 80 tracheostomies were performed during this time. Tracheostomy was performed at a median of six days after commencement of invasive ventilation, most commonly using the Ciaglia technique. Eighteen tracheostomies (23%) were performed surgically. The facilitation of weaning from invasive ventilation was the most common indication for tracheostomy. The median (IQR) time from tracheostomy to completion of weaning from mechanical ventilation was seven (4–11) days and from tracheostomy to decannulation was 14 (9–26) days. Eleven patients (14%) sustained complications possibly relating to tracheostomy insertion, three of whom subsequently died, although tracheostomy insertion was only possibly linked to one of these deaths. While our sample is small, it benchmarks a UK critical care network's tracheostomy practice in the UK.
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Affiliation(s)
- Steven Gill
- Consultant in Adult intensive Care Medicine and Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham
| | - Wei Yang Low
- Speciality Registrar in Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham
| | - J Mandy Coggon
- Clinical Nurse Educator for Critical Care, Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire
| | - Kerry Slaney
- Senior Sister, Intensive Care Unit, United Lincolnshire Hospitals NHS Trust, Lincoln
| | - Paul Stewart
- Consultant in Intensive Care Medicine, Burton Hospitals NHS Foundation Trust, Burton-upon-Trent
| | - Andrew Norton
- Consultant in Intensive Care Medicine, United Lincolnshire Hospitals NHS Trust, Boston
| | - Martin Beed
- Consultant in Adult Intensive Care Medicine and Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham
| | - Dale Gardiner
- Consultant in Adult Intensive Care Medicine, Nottingham University Hospitals NHS Trust, Nottingham
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14
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[Percutaneous tracheostomy through dilatation with the Ciaglia Blue Dolphin(®) method]. Med Intensiva 2014; 39:76-83. [PMID: 24598467 DOI: 10.1016/j.medin.2013.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/12/2013] [Accepted: 12/11/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the perioperative and postoperative complications in critically ill patients requiring percutaneous tracheostomy using the Ciaglia Blue Dolphin(®) technique. DESIGN A prospective, observational, cohort study was carried out. SCOPE Two medical-surgical Intensive Care Units. PATIENTS Adult patients subjected to prolonged mechanical ventilation. INTERVENTION Percutaneous tracheostomy using Ciaglia Blue Dolphin(®) with an endoscopic guide. VARIABLES Demographic variables, intraoperative and postoperative complications, and Intensive Care Unit and ward mortality were recorded. RESULTS Seventy patients were included. Age: 68.6 ± 12 years (68.6% males). APACHE II score: 23.5±8.7. Duration of mechanical ventilation prior to percutaneous tracheostomy: 14.3 ± 5.5 days. Perioperative complications were recorded in 25 patients. In 23 of them the complications were mild: difficulty inserting the tracheostomy cannula (n=10), mild bleeding (n=7), partial atelectasis (n=3), cuff leak (n=2), and technical inability to complete the procedure (switch to Ciaglia Blue Rhino(®)) (n=1). Severe complications were recorded in 2 patients: severe bleeding that forced completion of the procedure via surgical tracheostomy (n=1), and false passage with desaturation (n=1). None of the complications proved life-threatening. Eleven complications occurred in the learning curve. As postoperative complications, mild peri-cannula bleeding was seen in 2 patients. CONCLUSIONS Percutaneous tracheostomy using the Ciaglia Blue Dolphin(®) technique with an endoscopic guide is a safe procedure. As with other procedures, the learning curve contributes to increase the incidence of complications. Potential benefits versus other percutaneous tracheostomy techniques should be explored by randomized trials.
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15
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Cools-Lartigue J, Aboalsaud A, Gill H, Ferri L. Evolution of percutaneous dilatational tracheostomy--a review of current techniques and their pitfalls. World J Surg 2014; 37:1633-46. [PMID: 23571862 DOI: 10.1007/s00268-013-2025-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Tracheostomy is the most commonly performed surgical procedure in critically ill patients with acute respiratory failure. While few absolute indications exist, this procedure is widely used in patients with upper respiratory obstruction and those requiring long-term mechanical ventilation. The traditional approach to tracheostomy has been an open procedure performed in the operating room. This method is associated with an increased rate of complications and costs. Accordingly, percutaneous bedside tracheostomy procedures have largely replaced the traditional operative approach at many institutions. Numerous methods for percutaneous tracheostomy have thus emerged. However, the benefits of one technique versus another have not been well demonstrated. In this article, we review the evidence supporting the use of percutaneous tracheostomy procedures over the traditional operative approach. Furthermore, we review the currently available and emerging methods by which percutaneous tracheostomy can be performed. In addition, we highlight the available evidence concerning the safety and complication rates of each technique.
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Affiliation(s)
- Jonathan Cools-Lartigue
- LD MacLean Surgical Research Laboratories, Department of Surgery, Montreal General Hospital, McGill University, 1650 Cedar Avenue, L9-112, Montreal, QC, H3G 1A4, Canada
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16
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CABRINI L, LANDONI G, GRECO M, COSTAGLIOLA R, MONTI G, COLOMBO S, GRECO T, PASIN L, BORGHI G, ZANGRILLO A. Single dilator vs. guide wire dilating forceps tracheostomy: a meta-analysis of randomised trials. Acta Anaesthesiol Scand 2014; 58:135-42. [PMID: 24410105 DOI: 10.1111/aas.12213] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND Single dilator technique (SDT) and guide wire dilating forceps (GWDF) are the two most commonly used techniques of percutaneous dilatational tracheostomy (PDT) in critically ill adult patients. We performed a meta-analysis of randomised, controlled trials comparing intraoperative, mid-term and late complications of these two techniques. METHODS Pertinent studies were searched in BioMedCentral, PubMed, Embase and the Cochrane Central Register of clinical trials. We selected all randomised studies comparing SDT and GWDF techniques in adult critically ill patients published in a peer-reviewed journal. RESULTS Among 1040 retrieved studies, five eligible studies randomising 363 patients (181 to GWDF, 182 to SDT) were identified. The incidence of the composite outcome difficult cannula insertion/difficult dilation or failure was higher with the GWDF technique (15.5% vs. 4.9 %, P = 0.02). Moreover, intraprocedural bleeding was more common in the GWDF group (19.3% vs. 7.6% in SDT group, P = 0.018). A trend towards an increased incidence of fracture of tracheal rings was noted in the SDT group (6.5% vs. 0.5% in the GWDF group, P = 0.13). No difference in mid-term or long-term complications was observed. CONCLUSION GWDF technique is associated with a higher incidence of intraprocedural bleeding and of technical difficulties in completing the procedure (difficult cannula insertions/difficult dilations or failures) compared with the SDT technique. No differences were identified in mid-term and long-term complications. Further studies comparing SDT and GWDF in the general population and in subgroups of high-risk patients (like obese or hypoxaemic patients) are warranted.
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Affiliation(s)
- L. CABRINI
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Milan Italy
| | - G. LANDONI
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Milan Italy
| | - M. GRECO
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Milan Italy
| | - R. COSTAGLIOLA
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Milan Italy
| | - G. MONTI
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Milan Italy
| | - S. COLOMBO
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Milan Italy
| | - T. GRECO
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Milan Italy
| | - L. PASIN
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Milan Italy
| | - G. BORGHI
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Milan Italy
| | - A. ZANGRILLO
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Milan Italy
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17
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Parchani A, Peralta R, El-Menyar A, Tuma M, Zarour A, Kumar S, Abdulrahman H, AbdulRahman Y, Al-Thani H, Latifi R. Percutaneous dilatational tracheostomies in a newly established trauma center: a report from Qatar. Eur J Trauma Emerg Surg 2013; 39:507-10. [PMID: 26815448 DOI: 10.1007/s00068-013-0299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 05/19/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Percutaneous dilatational tracheostomy (PDT) is a routine surgical procedure for critically ill patients who require prolonged ventilatory support. METHODS We conducted a retrospective cohort study of all PDTs performed at the adult Trauma Intensive Care Unit (TICU) of Hamad Medical Corporation in Doha, Qatar, from January 2009 through September 2012. For all adult patients, we analyzed the demographic characteristics, mean ventilator time before the procedure, injury severity score (ISS), complications, and outcomes. RESULTS Of the 1,442 trauma patients admitted to the adult TICU during our study period, 124 (8.5 %) underwent PDT using the Ciaglia Blue Rhino technique. The vast majority were male (94.3 %). The mean age was 35 ± 15.6 years; mean ventilator time before the procedure, 12 ± 3 days; and mean ISS, 24.2 ± 9.3. More than half of patients had head injury (56 %), followed by chest and abdomen (26 %) and cervical spine injuries (18 %). Early complications included difficult tube placement (0.8 %), hypoxemia (0.8 %), minor bleeding (1.6 %), and hypotension (0.8 %), but the vast majority (93 %) of patients had no complications. The procedure-related mortality rate was 0 %. CONCLUSION PDT is safe and can be performed with minimal complications even in a newly established trauma center.
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Affiliation(s)
- A Parchani
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - R Peralta
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - A El-Menyar
- Weill Cornell Medical College, Doha, Qatar.,Clinical Research, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - M Tuma
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - A Zarour
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - S Kumar
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - H Abdulrahman
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Y AbdulRahman
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - H Al-Thani
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - R Latifi
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar. .,Weill Cornell Medical College, Doha, Qatar. .,Department of Surgery, University of Arizona, Tucson, AZ, USA.
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18
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Abstract
Tracheostomy is a commonly performed intervention with several benefits in the treatment of patients with chronic respiratory failure. Percutaneous dilational tracheostomy techniques have allowed bedside tracheostomy placement in the modern intensive care unit. Percutaneous dilational tracheostomy can be safely performed by interventional pulmonologists, medical intensive care physicians, and surgical specialists. When performed with the assistance of adjuncts, such as flexible bronchoscopy, the percutaneous dilational method has a favorable complication rate, efficiency, and cost profile compared with surgical tracheostomy.
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19
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Añón JM, Araujo JB, Escuela MP, González-Higueras E. [Percutaneous tracheostomy in the ventilated patient]. Med Intensiva 2013; 38:181-93. [PMID: 23347906 DOI: 10.1016/j.medin.2012.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 11/21/2012] [Accepted: 11/22/2012] [Indexed: 11/25/2022]
Abstract
The medical indications of tracheostomy comprise the alleviation of upper airway obstruction; the prevention of laryngeal and upper airway damage due to prolonged translaryngeal intubation in patients subjected to prolonged mechanical ventilation; and the facilitation of airway access for the removal of secretions. Since 1985, percutaneous tracheostomy (PT) has gained widespread acceptance as a method for creating a surgical airway in patients requiring long-term mechanical ventilation. Since then, several comparative trials of PT and surgical tracheostomy have been conducted, and new techniques for PT have been developed. The use of percutaneous dilatation techniques under bronchoscopic control are now increasingly popular throughout the world. Tracheostomy should be performed as soon as the need for prolonged intubation is identified. However a validated model for the prediction of prolonged mechanical ventilation is not available, and the timing of tracheostomy should be individualized. The present review analyzes the state of the art of PT in mechanically ventilated patients--this being regarded by many as the technique of choice in performing tracheostomy in critically ill patients.
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Affiliation(s)
- J M Añón
- Servicio de Medicina Intensiva, Hospital Virgen de la Luz, Cuenca, España.
| | - J B Araujo
- Servicio de Medicina Intensiva, Hospital Virgen de la Luz, Cuenca, España
| | - M P Escuela
- Servicio de Medicina Intensiva, Hospital Virgen de la Luz, Cuenca, España
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Kumar M, Trikha A, Chandralekha. Percutaneous dilatational tracheostomy: Griggs guide wire dilating forceps technique versus ULTRA-perc single-stage dilator - A prospective randomized study. Indian J Crit Care Med 2012; 16:87-92. [PMID: 22988363 PMCID: PMC3439784 DOI: 10.4103/0972-5229.99117] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Percutaneous dilatational tracheostomy (PDT) is a frequently performed surgical procedure on critically ill patients. This study was designed to compare its two methods: Griggs guide wire dilating forceps (GWDF) technique and the ULTRA-perc single-stage dilator technique
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Affiliation(s)
- Mritunjay Kumar
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
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Prieto-González M, López-Messa JB, Moradillo-González S, Franzón-Laz ZM, Ortega-Sáez M, Poncela-Blanco M, Alonso-Castañeira I, Andrés-de Llano J. [Results of an artificial airway management protocol in critical patients subjected to mechanical ventilation]. Med Intensiva 2012; 37:400-8. [PMID: 22959860 DOI: 10.1016/j.medin.2012.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 06/20/2012] [Accepted: 07/18/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the results of the implementation of a protocol in an intensive care unit (ICU) referred to critically ill patients requiring a prolonged artificial airway. DESIGN A prospective, observational cohort study was carried out. INTERVENTION Management strategies were established on the airway by endotracheal intubation (ETI) or tracheostomy, and guidelines were developed for action in the decannulation process. SETTING A polyvalent ICU. PATIENTS We studied 169 patients subjected to mechanical ventilation (MV), 67 with ETI ≥ 10 days of MV and 102 with percutaneous (PT) or surgical tracheostomy (TQ). VARIABLES OF INTEREST ICU and hospital stays, days of ETI and MV, mortality, tracheostomy, anatomical risk factors, surgical complications, and postoperative decannulation period. RESULTS ETI versus tracheotomy involved fewer days of MV (17 vs. 30 days, p<0.001), a shorter ICU stay (20 vs. 35 days, p<0.001), and a shorter hospital stay (34 vs. 51 days, p<0.001).There were more TQ procedures in patients with risk factors (47% TP vs. 89% TQ, p<0.001). Intraoperative minor bleeding was the most common complication, being associated with TQ (31% vs. 11%, p = 0.03). TP was associated with a shorter cannulationperiod (25 days vs. 34 days, p<0.04). CONCLUSIONS The protocol variants showed no differences in terms of complications and mortality, when orienting application to patients with similar characteristics.
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Affiliation(s)
- M Prieto-González
- Servicio de Cuidados Intensivos, Complejo Asistencial de Palencia, Palencia, España.
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CABRINI L, MONTI G, LANDONI G, BIONDI-ZOCCAI G, BOROLI F, MAMO D, PLUMARI VP, COLOMBO S, ZANGRILLO A. Percutaneous tracheostomy, a systematic review. Acta Anaesthesiol Scand 2012; 56:270-81. [PMID: 22188176 DOI: 10.1111/j.1399-6576.2011.02592.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2011] [Indexed: 02/05/2023]
Abstract
BACKGROUND Percutaneous dilatational tracheostomy (PDT) is a common procedure in intensive care units and the identification of the best technique is very important. We performed a systematic review and meta-analysis of randomized studies comparing different PDT techniques in critically ill adult patients to investigate if one technique is superior to the others with regard to major and minor intraprocedural complications. METHODS BioMedCentral and other database of clinical trials were searched for pertinent studies. Inclusion criterion was random allocation to at least two PDT techniques. Exclusion criteria were duplicate publications, nonadult studies, and absence of outcome data. STUDY DESIGN Population, clinical setting, and complications were extracted. RESULTS Data from 1130 patients in 13 randomized trials were analyzed. Multiple dilators, single-step dilatation, guide wire dilating forceps, rotational dilation, retrograde tracheostomy, and balloon dilation techniques were always performed in the intensive care unit. The different techniques and devices appeared largely equivalent, with the exception of retrograde tracheostomy, which was associated with more severe complications and more frequent need of conversion to other techniques when compared with guide wire dilating forceps and single-step dilatation techniques. Single-step dilatation technique was associated with fewer failures than rotational dilation, and fewer mild complications in comparison with balloon dilation and guide wire dilating forceps (all P < 0.05). CONCLUSIONS Among the six analyzed techniques, single-step dilatation technique appeared the most reliable in terms of safety and success rate. However, the number of available randomized trials was insufficient to confidently assess the best PDT technique.
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Affiliation(s)
| | | | | | - G. BIONDI-ZOCCAI
- Division of Cardiology; University of Modena and Reggio Emilia; Modena; Italy
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Fikkers BG, Staatsen M, van den Hoogen FJA, van der Hoeven JG. Early and late outcome after single step dilatational tracheostomy versus the guide wire dilating forceps technique: a prospective randomized clinical trial. Intensive Care Med 2011; 37:1103-9. [PMID: 21484081 PMCID: PMC3127000 DOI: 10.1007/s00134-011-2222-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 03/18/2011] [Indexed: 11/18/2022]
Abstract
Purpose Percutaneous tracheostomy is frequently performed in long-term ventilated patients in the intensive care unit (ICU). Unfortunately, despite many years of experience, the optimal technique is still unknown, especially considering the occurrence of late complications. The purpose of this study was to determine which of the two most frequently used percutaneous tracheostomy techniques performs best with the emphasis on late complications. Methods This prospective randomized trial involved 120 patients, comparing two techniques of percutaneous tracheostomy, the guide wire dilating forceps (GWDF) and the single step dilatational tracheostomy (SSDT) technique. Results Sixty patients in each group underwent a percutaneous tracheostomy and were followed for up to 3 months after decannulation. The majority of complications in both groups were minor (58.3% in the GWDF group and 61.7% in the SSDT group). We found a trend towards more major perioperative complications in the GWDF group versus the SSDT group, 10.0 versus 1.7% (p = 0.06). One patient in the SSDT group developed a significant tracheal stenosis. However, this may also have been related to prolonged translaryngeal intubation. Results of magnetic resonance imaging (MRI) investigations showed only minor tracheal changes. Only 37.5% of patients in the GWDF group and 31.8% in the SSDT group had no complaints after their percutaneous tracheostomy. Conclusion Compared with the GWDF, the SSDT shows a trend toward less major perioperative complications with a comparable long-term outcome.
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Affiliation(s)
- Bernard G Fikkers
- Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9600, 6500 HB, Nijmegen, The Netherlands.
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Dempsey GA, Grant CA, Jones TM. Percutaneous tracheostomy: a 6 yr prospective evaluation of the single tapered dilator technique. Br J Anaesth 2010; 105:782-8. [PMID: 20813838 DOI: 10.1093/bja/aeq238] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The single tapered dilator (STD) percutaneous dilatational tracheostomy (PDT) technique now appears to be the single most common method of performing a tracheostomy in the critical care unit (CCU). METHODS A single-centre, prospective evaluation of all PDTs performed in an adult mixed surgical and medical CCU between November 2003 and October 2009 was done. All procedures were undertaken by critical care physicians. A proforma recorded intraoperative complications and technical difficulties encountered during the procedure; all patients were followed up for a minimum of 3 months for delayed complications. RESULTS A tracheostomy was performed on 589 patients during the study period. PDT was attempted in 576 patients and successfully completed in 572. PDT was abandoned in four patients due to bleeding, with three of these subsequently undergoing surgical tracheostomy (ST). ST was performed in 17 patients. Intraoperative technical difficulties were encountered in 149 (26%) cases. Sixteen (3%) procedures were deemed as having early complications. A further four (0.7%) cases had significant late complications including two tracheo-innominate fistulae (TIF). Both TIF patients died as a result of their complications giving a mortality directly attributable to PDT of 0.35%. There were no differences with respect to the occurrence of complications according to grade of operator. CONCLUSIONS PDT performed by the STD technique is a relatively safe procedure with more than 96% of procedures performed without any early or late complications. Using this technique, more than 97% of tracheostomies undertaken during the study period were performed percutaneously. Further audit at a national level is warranted to fully evaluate long-term complications after PDT.
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Affiliation(s)
- G A Dempsey
- Critical Care Unit, Aintree University Hospitals, Lower Lane, Liverpool L9 7AL, UK.
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Divisi D, Altamura G, Di Tommaso S, Di Leonardo G, Rosa E, De Sanctis C, Crisci R. Fantoni translaryngeal tracheostomy versus ciaglia blue rhino percutaneous tracheostomy: A retrospective comparison. Surg Today 2009; 39:387-92. [DOI: 10.1007/s00595-008-3899-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Accepted: 07/28/2008] [Indexed: 11/24/2022]
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Díaz-Regañón G, Miñambres E, Ruiz A, González-Herrera S, Holanda-Peña M, López-Espadas F. Safety and complications of percutaneous tracheostomy in a cohort of 800 mixed ICU patients. Anaesthesia 2008; 63:1198-203. [PMID: 18717657 DOI: 10.1111/j.1365-2044.2008.05606.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Percutaneous tracheostomy is used primarily to assist weaning from mechanical ventilation in the intensive care unit. We report our experiences of 800 such procedures performed in the intensive care unit by a collaborative team (critical care and ENT specialists). Most procedures (85.6%) were performed by residents supervised by the intensive care unit staff. Complications occurred in 32 patients (4%). Intraprocedural complications occurred in 17 patients (2.1%), early postprocedural complications in six (0.75%), and late postprocedural complications in nine (1.1%). No deaths were directly related to percutaneous tracheostomy. The incidence of complications was greater in percutaneous tracheostomy performed by the residents during their initial five attempts compared to their later attempts (9.2% vs 2.6%, p < 0.05). The low incidence of complications indicates that bedside percutaneous tracheostomy can be performed safely as a routine procedure in daily care of intensive care unit patients.
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Affiliation(s)
- G Díaz-Regañón
- Service of Intensive Care Medicine, Hospital Universitario Marqués de Valdecilla, Avenida Marqués de Valdecilla s/n, E-39008 Santander, Spain
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Bhatti N, Tatlipinar A, Mirski M, Koch WM, Goldenberg D. Percutaneous dilation tracheotomy in intensive care unit patients. Otolaryngol Head Neck Surg 2007; 136:938-41. [PMID: 17547983 DOI: 10.1016/j.otohns.2006.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Accepted: 12/01/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVES In our department, we routinely use percutaneous dilation tracheotomy (PDT) in select intensive care unit (ICU) patients requiring prolonged intubation and mechanical ventilation. We present our experience with this technique and discuss the pros and cons of PDT in the intensive care setting. STUDY DESIGN AND SETTING We conducted a retrospective study of consecutive PDTs performed in our institution between 2002 and 2004. Demographic information and procedural and postoperative complications were noted. RESULTS Two hundred seventy-four PDTs were performed on intensive care unit patients during this time period. Complications included five cases of excessive intraoperative bleeding (1.8%), one postoperative hemorrhage (0.3%), one tracheoesophageal fistula (0.3%), one pneumothorax (0.3%), and four accidental decannulations (1.4%). No PDT-associated deaths occurred. CONCLUSIONS PDT is advantageous for the patient as it is performed at bedside in the ICU. It is our conclusion that this technique is suitable for many, but not all, critical care patients.
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Affiliation(s)
- Nasir Bhatti
- Department of Ototolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Niskanen M, Purhonen S, Koljonen V, Ronkainen A, Hirvonen E. Fatal inhalation injury caused by airway fire during tracheostomy. Acta Anaesthesiol Scand 2007; 51:509-13. [PMID: 17378792 DOI: 10.1111/j.1399-6576.2007.01280.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 45-year-old man needed emergency tracheostomy and cranioplasty. He was intubated with a cuffed oral polyvinylchloride endotracheal tube and ventilated with 100% oxygen before tracheal incision. During opening of the trachea using diathermy, a popping sound was heard and flames originating from the tracheal incision were observed. The endotracheal tube was charred and its lumen had melted. Immediately after the incident, bronchofibroscopic examination revealed inhalation injury. After remaining for 8 weeks in hospital, the patient was transferred to a health care centre, where he was found dead in his bed.
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Affiliation(s)
- M Niskanen
- Department of Anaesthesiology and Intensive Care, ENT Hospital, Helsinki University Central Hospital, Helsinki, Finland.
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Sheu CC, Tsai JR, Hung JY, Cheng MH, Chong IW, Hwang JJ, Huang MS. A simple modification of Ciaglia Blue Rhino technique for tracheostomy: using a guidewire dilating forceps for initial dilation. Eur J Cardiothorac Surg 2006; 31:114-9. [PMID: 17067807 DOI: 10.1016/j.ejcts.2006.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2006] [Revised: 10/01/2006] [Accepted: 10/09/2006] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The potential difficulty in doing initial dilation in the percutaneous dilational tracheostomy (PDT) with the Ciaglia Blue Rhino (CBR) technique has been reported by others and encountered in our clinical practice. To resolve this problem, we developed a modified CBR technique by using a guidewire dilating forceps (GWDF) to facilitate initial dilation. The present before-and-after comparison study aimed to evaluate the clinical benefits of this modified CBR technique. METHODS Consecutive 120 patients undergoing CBR technique in the pre-conversion year and 114 patients undergoing GWDF-CBR technique in the post-conversion year were enrolled for analysis. The procedure time and procedure-related complications were compared between these two groups. RESULTS The mean procedure time with GWDF-CBR technique was 4.5+/-1.6min, significantly shorter than 5.7+/-3.0min with CBR technique (p<0.001). Only two patients in the GWDF-CBR group required prolonged procedure time (>8min), compared with 14 patients in the CBR group. Thirty three (27.5%) of 120 patients undergoing CBR technique and 15 (13.1%) of 114 patients undergoing GWDF-CBR technique had PDT-related complications (p=0.006). Most of the complications were minor and transient. Only 13 patients in the CBR group and 3 patients in the GWDF-CBR group encountered major complications (10.8% vs 2.6%, p=0.012). Regarding the high-risk patients, 21 (36.2%) of 58 patients in the CBR group and 9 (15.8%) of 57 patients in the GWDF-CBR group had PDT-related complications (p=0.011). CONCLUSIONS Pre-dilation with a GWDF in the CBR technique helped to prevent prolonged procedure time and procedure-related complications. We suggest that the bronchoscopy-guided GWDF-CBR serves an easy-to-operate and relatively safe PDT technique for critically ill patients.
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Affiliation(s)
- Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
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Zgoda MA, Berger R. Balloon-facilitated percutaneous dilational tracheostomy tube placement: preliminary report of a novel technique. Chest 2005; 128:3688-90. [PMID: 16304334 DOI: 10.1378/chest.128.5.3688] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To describe a novel technique for percutaneous tracheotomy (PT) that could be an alternative to current dilational techniques. DESIGN An observational animal study of PT was performed using the Seldinger guide wire technique with a tracheostomy tube preloaded onto a dilational balloon catheter. A small skin incision was done with an 11-blade scalpel, but no blunt subcutaneous tissue dissection was performed. SETTING Animal laboratory in a university hospital. SUBJECTS Seven adult pigs (approximate weight, 16 to 21 kg). MEASUREMENTS AND RESULTS Successful tracheostomy was accomplished in all seven pigs without apparent complication. Vital signs and oximetry results remained unchanged throughout the procedure. The mean duration of the procedure was 5.5 min from tracheal puncture to ventilation. CONCLUSION This novel procedure is a simple and effective means of PT tube placement without subcutaneous tissue dissection and could potentially have decreased complications when compared to the standard methods of PT currently employed in humans. Human studies are pending.
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Affiliation(s)
- Michael A Zgoda
- University of Kentucky Division of Pulmonary/Critical Care & Sleep Medicine, University of Kentucky Medical Center, Lexington, 40536, USA.
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Abstract
Tracheostomy is a common critical care procedure in patients with acute respiratory failure who require prolonged mechanical ventilatory support. Tracheostomy usually is considered if weaning from mechanical ventilation has been unsuccessful for 14 to 21 days. A recent clinical trial suggested that early tracheostomy may benefit patients who are not improving and who are expected to require prolonged respiratory support. In this study, early tracheostomy improved survival and shortened duration of mechanical ventilation. Minimally invasive bedside percutaneous tracheostomy was introduced recently as an alternative to the traditional surgical technique. In expert hands, the 2 techniques are equivalent in complications and safety; however, the bedside percutaneous approach may be more cost-effective. Tracheostomy should be considered early (within the first week of mechanical ventilation) in patients with a high likelihood of prolonged mechanical ventilation. Depending on local medical expertise and costs, either the percutaneous or the surgical technique may be used.
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Affiliation(s)
- Sameer Rana
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Bardell T, Drover JW. Recent developments in percutaneous tracheostomy: improving techniques and expanding roles. Curr Opin Crit Care 2005; 11:326-32. [PMID: 16015110 DOI: 10.1097/01.ccx.0000170680.09759.f2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update of recent developments pertaining to the use of percutaneous tracheostomy. Percutaneous tracheostomy has been established as an alternative to open surgical tracheostomy, but many key questions about the optimal use of this procedure remain unanswered. RECENT FINDINGS Issues in percutaneous tracheostomy that have been addressed in the recent literature include the optimal method, timing, use of percutaneous tracheostomy in emergencies, safety in high-risk populations, confirmation of tracheal puncture, and outcomes. SUMMARY Recent literature suggests that percutaneous tracheostomy is safe to use in an expanding population of patients, including patients with airway compromise and thrombocytopenia. Several methods seem to be safe alternatives to that originally described. Capnography has arisen as an alternative to bronchoscopy for confirmation of tracheal puncture. Recent evidence highlights that although tracheostomy may improve short-term outcome, these critically ill patients have a significant long-term risk of poor outcome. This must be taken into consideration when this procedure is offered.
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Affiliation(s)
- Trevor Bardell
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
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Fikkers BG, Staatsen M, Lardenoije SGGF, van den Hoogen FJA, van der Hoeven JG. Comparison of two percutaneous tracheostomy techniques, guide wire dilating forceps and Ciaglia Blue Rhino: a sequential cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2004; 8:R299-305. [PMID: 15469572 PMCID: PMC1065019 DOI: 10.1186/cc2907] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2004] [Revised: 05/07/2004] [Accepted: 06/11/2004] [Indexed: 01/28/2023]
Abstract
Introduction To evaluate and compare the peri-operative and postoperative complications of the two most frequently used percutaneous tracheostomy techniques, namely guide wire dilating forceps (GWDF) and Ciaglia Blue Rhino (CBR). Methods A sequential cohort study with comparison of short-term and long-term peri-operative and postoperative complications was performed in the intensive care unit of the University Medical Centre in Nijmegen, The Netherlands. In the period 1997–2000, 171 patients underwent a tracheostomy with the GWDF technique and, in the period 2000–2003, a further 171 patients with the CBR technique. All complications were prospectively registered on a standard form. Results There was no significant difference in major complications, either peri-operative or postoperative. We found a significant difference in minor peri-operative complications (P < 0.01) and minor late complications (P < 0.05). Conclusion Despite a difference in minor complications between GWDF and CBR, both techniques seem equally reliable.
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Affiliation(s)
- Bernard G Fikkers
- Department of Intensive Care, University Medical Centre Nijmegen, The Netherlands.
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