Abstract
Purpose:To study the feasibility of using the pro-seal laryngeal mask airway (LMA) for airway maintenance during bronchoscopic-guided percutaneous tracheostomy.Materials and Methods:Observational study of 60 patients in a 16-bed intensive care unit. The patient’s tracheal tube was exchanged for a pro-seal LMA before undertaking percutaneous tracheostomy.Results:Inspiratory pressure and tidal volumes achieved during the procedure were recorded. The median peak inspiratory pressure was 25 (standard deviation 4.4) cm H2O. There was no loss of tidal volume in 30 patients, a loss of less than 100 mL/breath in 27, and loss of more than 100 mL in 3 patients. A pro-seal LMA successfully maintained the airway and allowed adequate ventilation during per-cutaneous tracheostomy in all 60 patients. In all patients, fiber optic bronchoscopy through the pro-seal LMA provided a clear view of the cords and trachea and there was no laryngeal or tracheal soiling at any stage of the procedure.Conclusion:The pro-seal LMA provides a reliable airway and allows effective ventilation during percutaneous tracheostomy. The passage of a fiberscope through the pro-seal LMA and glottis is easy and provides a clear view of the upper trachea.
Highlights
To study the feasibility of using the pro-seal laryngeal mask airway (LMA) for airway maintenance during bronchoscopic-guided percutaneous tracheostomy
Using percutaneous dilatational tracheostomy the patient’s airway is usually maintained with an endotracheal tube, which is pulled back until the cuff is lying across the vocal cords.[1,2]
In five male patients the size 4 pro-seal LMA was changed to a size 5 and in three female patients the size 3 pro-seal LMA was changed to a size 4 to provide a better seal with the larynx
Summary
To study the feasibility of using the pro-seal laryngeal mask airway (LMA) for airway maintenance during bronchoscopic-guided percutaneous tracheostomy. The patient’s tracheal tube was exchanged for a pro-seal LMA before undertaking percutaneous tracheostomy. Fiber optic bronchoscopy through the pro-seal LMA provided a clear view of the cords and trachea and there was no laryngeal or tracheal soiling at any stage of the procedure. A direct laryngoscopy done in all patients to assess the airways, after satisfactory findings, the tracheal tube was removed, a pro-seal LMA inserted (size 3 for females and size 4 for males), and the cuff inflated. Correct positioning of the pro-seal LMA was confirmed by the achievement of an adequate expired tidal volume with minimal leak from the drain tube and appearance of capnograph. The aim of this observational study was to evaluate the efficacy of the pro-seal LMA during PDT under bronchoscopic guidance
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