Improvement of the Dilatational Tracheostomy Technique

Abstract

Objective: To describe an improved technique for dilatational tracheostomy. Clinical case: We report a case of severe community-acquired polysegmental viral pneumonia, grade 2 respiratory failure. After the start of antiviral therapy and staged respiratory support, the female patient was placed on mechanical ventilation 12 hours following hospital admission due to an increasing systemic inflammatory response and cytokine storm. In 20 hours, a dilatational tracheostomy using a modified technique was performed. Advantages of the modified technique are low trauma, short duration (5-10 minutes), significantly rarer wound infection (important benefit due to the COVID-19 features), significantly rarer postoperative scarring and cicatricial stenosis of the trachea. Technical improvement of dilatational tracheostomy allows for optimal management of critically ill patients (multiple organ failure, severe sepsis, considerable total body surface area burns with concomitant inhalation injury), which will significantly increase treatment efficiency, reduce the number of complications, and speed up the hospital discharge.