Use of I-Gel facilitates percutaneous dilatational tracheostomy in the ICU. A preliminary report.

Abstract

The purpose is to test the feasibility of using the I-Gel® device for airway maintenance during bronchoscopic-guided percutaneous dilatational tracheostomy (PDT). Usually PDT is accomplished via the tracheal tube. Some severe complications during PDT may be related to poor visualization of tracheal structures. The alternative implies insertion of an I-Gel®. Subjectively, the bronchoscopic view obtained via an I-Gel® seems to be better than that obtained through an endotracheal tube (ET). The bedside PDT was performed using the Blue Dolphin method in 15 patients in ICU. Before undertaking bronchoscopic-guided PDT, the patient’s ET was exchanged for I-Gel®, as a ventilatory device for airway maintenance. The insertion of the I-Gel®, the quality of ventilation, the blood gas values, the view of the tracheal puncture site, and the view of the balloon dilatation were reported. The I-Gel® successfully maintained the airway and allowed adequate ventilation during PDT in all patients. The ratings were good in all cases with regards to ventilation and to blood gas analysis, for identification of relevant structures and tracheal puncture site, and for the view inside the trachea during PDT. Our preliminary experience suggests that the I-Gel® can be used to safely maintain the airway during PDT. The I-Gel® provides a reliable airway and allows effective ventilation during PDT. This method improves visualization of the trachea and larynx and prevents the difficulties associated with the use of an ET such as cuff puncture, tube transection by the needle, accidental extubation, and bronchoscope lesions.