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Sathiyabama S. Cricothyrotomy - In Unanticipated Difficult Intubation Cases with Respiratory Compromise. Int Arch Otorhinolaryngol 2024; 28:e307-e313. [PMID: 38618597 PMCID: PMC11008948 DOI: 10.1055/s-0043-1776726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/15/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Cricothyrotomy, percutaneous dilation tracheostomy, and tracheostomy are all cost-effective and safe techniques used in the management of critically ill patients who need an artificial airway other than endotracheal tube ventilation. The present study focused on enlightening on elective and emergency procedures performed on conditions present with difficult airways and also attempts to shed light on the aspects of securing an airway in anticipated and unanticipated difficult intubation. Objective The objective of the study was to compare the three procedures conducted during difficult airway/failed intubation situations. Methods The present retrospective observational study was conducted collecting data from patient files obtained at a tertiary healthcare center from 2013 to 2018. The difficult intubation cases were managed by ear, nose, and throat (ENT) surgeons. The study compared three methods: Cricothyrotomy, percutaneous dilation tracheostomy, and tracheostomy based on factors such as procedure duration, complications, and the instruments required for each procedure. Results The study enrolled 85 patients, 61 males and 24 females, aged between 30 and 70 years old. To perform cricothyrotomy, only a simple blade was required. Cricothyrotomy had the shortest operating time (4.1±3.1 minutes) and the shortest time of full oxygen saturation (3 min). Percutaneous tracheostomy had the least amount of bleeding (1%). Cricothyrotomy significantly showed the least intraoperative bleeding than percutaneous dilation, tracheostomy, and tracheostomy ( p = 0.001). Conclusion Cricothyrotomy is preferable as it takes less time to perform, causes less bleeding, and takes the least time for full oxygen saturation than tracheostomy and percutaneous dilatational tracheostomy in "can't intubate, can't oxygenate" patients.
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Affiliation(s)
- S Sathiyabama
- Department of ENT, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Kim SY, Lee SW, Baek A, Park KN. Comparison between Real-Time Ultrasound-guided Percutaneous Dilatational Tracheostomy and Surgical Tracheostomy in critically ill Patients: A Randomized Controlled Trial. Clin Exp Otorhinolaryngol 2023; 16:388-394. [PMID: 37752796 DOI: 10.21053/ceo.2023.01088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVES Tracheostomy is an important procedure for critically ill patients in the intensive care unit (ICU), and percutaneous dilatational tracheostomy (PDT) has gained popularity due to its safety and effectiveness. However, there are limited data comparing ultrasound-guided PDT (US-PDT) with surgical tracheostomy (ST). In our previous study, we reported that US-PDT had similar safety and effectiveness to ST, with a shorter procedure time. However, the study design was retrospective, and the sample size was small. Therefore, we conducted a randomized controlled trial to demonstrate the safety and efficacy of US-PDT compared to ST. METHODS A total of 70 patients who underwent either US-PDT (n=35) or ST (n=35) were enrolled in the study between October 20, 2020 and July 26, 2022. The patients were randomly assigned to their respective procedures. The data collected included patient clinical characteristics, procedure time and details, complications, duration of ICU stay, time taken for weaning from mechanical ventilation, and hospital mortality. RESULTS The procedure time of US-PDT was shorter than that of ST (4.0±2.2 minutes vs. 10.1±4.6 minutes). The incision length of US-PDT was also shorter than that of ST (1.5±0.5 cm vs. 1.8±0.4 cm). There were no statistically significant differences in demographics, procedure details, complications, length of ICU stay, ventilator weaning time, and hospital mortality. CONCLUSION US-PDT has a similar complication rate and shorter procedure time compared with ST. It can be safely and effectively performed in critically ill patients and can serve as a potential alternative to ST.
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Affiliation(s)
- Shin Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seung Won Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Aerin Baek
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ki Nam Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Omar AS, Sudarsanan S, AlKhulaifi A. Unusual bronchoscopic value in percutaneous dilatational tracheostomy: A case report. World J Anesthesiol 2020; 9:3-6. [DOI: 10.5313/wja.v9.i1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/10/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The usage of bronchoscopy during percutaneous dilatational tracheostomy remains under debate. The proponents of bronchoscopy advocating safety of the procedure, whereas the critics raising the concerns about the cost, possible delay in the procedure, and waiting for the device.
CASE SUMMARY We are highlighting a case of percutaneous dilatational tracheostomy where bronchoscopy aided in diagnosing a rare situation of wire entrapment within the endotracheal tube, treated by withdrawing the wire from the endotracheal tube with good outcome.
CONCLUSION The bronchoscopy guided approach permitted early diagnosis and helped to end the procedure without complication or possible major surgery in a case of accidental wire puncture of the endotracheal tube.
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Affiliation(s)
- Amr Salah Omar
- Department of Cardiothoracic Surgery/Cardiac Anaesthesia and Intensive Care Units, Hamad Medical Corporation, Doha 3050, Qatar
| | - Suraj Sudarsanan
- Cardiothoracic surgery, Hamad medical corporation, Doha 3050, Qatar
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Lim SY, Kwack WG, Kim Y, Lee YJ, Park JS, Yoon HI, Lee JH, Lee CT, Cho YJ. Comparison of outcomes between vertical and transverse skin incisions in percutaneous tracheostomy for critically ill patients: a retrospective cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:246. [PMID: 30268131 PMCID: PMC6164179 DOI: 10.1186/s13054-018-2174-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 08/30/2018] [Indexed: 12/19/2022]
Abstract
Background Percutaneous tracheostomy (PT) is a common procedure in critical care medicine. No definite clinical practice guidelines recommended on the choice of the direction of skin incision, vertical or transverse for tracheostomy in critically ill patients. The objective of this retrospective study was to compare the outcomes associated with vertical and transverse skin incisions in patients undergoing PT. Methods Patients who underwent PT between March 2011 and December 2015 in the intensive care unit (ICU) of a tertiary hospital were retrospectively included. PTs were performed by pulmonary intensivists at the ICU bedside using the single tapered dilator technique assisted by flexible bronchoscopy. The primary outcome was the incidence of tracheostomy site ulcers at 7 days after PT. Results Of the 458 patients who underwent PT, a vertical incision was made in 27.1% and a transverse incision was made in 72.9%. There were no tracheostomy-related mortalities, and no significant difference in the incidence of immediate postoperative complications, including bleeding, tracheal ring fracture, and subcutaneous emphysema. Thirty-five patients (7.6%) developed complications within 7 days after PT, in which tracheostomy-related pressure ulcers were the most frequent. Compared with vertical incisions, transverse incisions were associated with significantly lower incidence of complications (14.1% vs. 5.4%, P = 0.001). Conclusions This retrospective study showed that transverse skin incisions in PTs for critically ill patients, resulted in a significant decrease in overall complications, particularly ulcers in the tracheostomy site.
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Affiliation(s)
- Sung Yoon Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Won Gun Kwack
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Youlim Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Ho Il Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Jae Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Choon-Taek Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
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Park JY, Lee T, Lee H, Lee JH, Lee CT, Cho YJ. A Case of Laryngeal Mask Airway-Assisted Percutaneous Dilatational Tracheostomy. Korean J Crit Care Med 2013. [DOI: 10.4266/kjccm.2013.28.3.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ji Young Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Taehoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hongyeul Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Choon-Taek Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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