Retrosternal Percutaneous Tracheostomy: An Approach for Predictably Impossible Classic Tracheostomy

Philippe Biderman,Oded Szold,Eyal Raz,Eyal Porat,Yael Rafaeli,Ory Wiesel,Avi A Weinbroum

doi:10.1155/2010/397270

Abstract

Percutaneous tracheostomy is a routine procedure in intensive care units. In cases of very low position of the larynx, cervical spine deformation, morbid obesity, or neck tumor, performance of the classic tracheostomy is inapplicable. Retrosternal approach to tracheostomy in such 20 patients is herein reported. After preoperative neck computerized tomography to define the neck anatomy, a small suprasternal incision followed by a short retrosternal tissue dissection to expose the trachea was done; the trachea was then catheterized at the level of the 2nd ring in the usual tracheostomy manner. The immediate and late (≥6 months) outcomes were similar to that of the standard tracheostomy. Thus, percutaneous retrosternal tracheostomy is safe in patients with abnormal positioning of the trachea or neck constitution. It is a bedside applicable technique, that, however, requires caution to avoid hazardous vascular complications.

Highlights

Tracheostomy has become a common practice in the ICU, despite of the recent study that failed to demonstrate any major benefit versus prolonged intubation [1]
Retrosternal percutaneous tracheostomy (PCT) was withheld in one patient at the last minute, because of the medial and high position of the innominate artery; he remained intubated and ventilated through an endotracheal tube (ETT)
We describe a straightforward and safe modified PCT technique that provides a solution to situations where the standard open tracheostomy is impossible, due to neck impediments or anatomical abnormalities, and where the only alternative could be the splitting of the sternum

Summary

Introduction

Tracheostomy has become a common practice in the ICU, despite of the recent study that failed to demonstrate any major benefit versus prolonged intubation [1]. The percutaneous tracheostomy (PCT) technique has become very popular in ICUs over the past decade, and several publications have favorably compared its safety to that of the standard open surgical tracheostomy [3, 4]. It is the procedure of choice for elective tracheostomy in many critically ill adult patients [3]. Additional advantages of PCT are the reduction in lag time between intubation and tracheostomy, and cosmetic considerations, all accounting for the popularity of the PCT in the ICU [6]

Methods

Results

Conclusion