Percutaneous Dilatational Tracheostomy Procedure Research Articles

Evaluation of the Effect of Morphological Structure on Dilatational Tracheostomy Interference Location and Complications with Ultrasonography and Fiberoptic Bronchoscopy.

Background: Percutaneous dilatational tracheostomy (PDT) is the most commonly performed minimally invasive intensive care unit procedure worldwide. Methods: This study evaluated the percentage of consistency between the entry site observed with fiberoptic bronchoscopy (FOB) and the prediction for the PDT level based on pre-procedural ultrasonography (USG) in PDT procedures performed using the forceps dilatation method. The effect of morphological features on intervention sites was also investigated. Complications that occurred during and after the procedure, as well as the duration, site, and quantity of the procedures, were recorded. Results: Data obtained from a total of 91 patients were analyzed. In 57 patients (62.6%), the USG-estimated tracheal puncture level was consistent with the intercartilaginous space observed by FOB, while in 34 patients (37.4%), there was a discrepancy between these two methods. According to Bland Altman, the agreement between the tracheal spaces determined by USG and FOB was close. Regression formulas for PDT procedures defining the intercartilaginous puncture level based on morphologic measurements of the patients were created. The most common complication related to PDT was cartilage fracture (17.6%), which was proven to be predicted with maximum relevance by punctured tracheal level, neck extension limitation, and procedure duration. Conclusions: In PDT procedures using the forceps dilatation method, the prediction of the PDT intervention level based on pre-procedural USG was considerably in accordance with the entry site observed by FOB. The intercartilaginous puncture level could be estimated based on morphological measurements.

Percutaneous Dilatational Tracheostomy; Diagnosis and Mortality Rate in Intensive Care Saiful Anwar Hospital

Introduction: Tracheostomy is a common surgical procedure performed on critically ill intensive care patients. Reports have documented considerable associated morbidity, with complication rates varying from 6 to 66%. The reports on mortality associated with tracheostomy range from 0 to 5%. Since its introduction, percutaneous dilatational tracheostomies (PDT) have gained increasing popularity. The most commonly cited advantages are the ease of the familiar technique and the ability to perform the procedure at the bedside.7 This paper aims to study the mortality rate and diagnosis of patients who performed the percutaneous dilatational tracheostomy procedure in the ICU of Saiful Anwar Malang Hospital.
 Methods: Observational analytical research is carried out cross-sectionally. Data was collected from the medical records of patients undergoing PDT for the period July 2022 – October 2022. Statistical analysis using the Chi-square test.
 Results: From 39 subjects, 34 (87.2%) subjects experienced respiratory failure. The most common cause was HAP pneumonia (61.5%), followed by CVA (17.9%) and CAP pneumonia (12.8%); the rest were EDH, SAH, and ASD secundum, as much as 2.6%. The outcome was that 13 (33.3%) subjects died, and the rest survived and were transported to a care ward. Correlation between patient outcomes with respiratory failure p=0.735, with diagnosis p=0.309.
 Conclusion: The most common diagnosis of PDT is HAP pneumonia. There was no significant correlation between diagnosis and mortality of patients performed by PDT.

Yoğun Bakım Ünitesinde Fiberoptik Bronkoskopi Kılavuzluğunda Perkütan Dilatasyonel Trakeostomiye Karşı Klasik Kör Perkütan Dilatasyonel Trakeostomi: Komplikasyonlar, Mortalite ve Sonuçlar

Aim: This study aimed to compare percutaneous dilatational tracheostomy (PDT) procedures performed with fiberoptic bronchoscopy (FOB) guidance and classical blind technique regarding complications, mortality, and patient outcomes. Material and Methods: This study included 62 patients receiving mechanical ventilator support in the intensive care unit (ICU) between October 2022 and June 2023. Patients were randomized into two groups: those who underwent FOB-guided PDT (group FOB, n=31) and those who underwent PDT with the classical blind technique (group C, n=31). Demographic data, clinical characteristics, PDT procedure times, complications, and mortalities were analyzed. Results: The median age was 64 (range, 19-94) years, and 67.7% (n=42) of the patients were male. Demographic data were found similar between groups. The most common primary diagnosis in patients who underwent PDT was intracranial hemorrhages (32.3%, n=20). While the median tracheostomy opening time in the entire study group was 13 (range, 3-31) days, there was no significant difference between the groups (p=0.637). The mean PDT procedure time (9.6±3.8 vs 12.6±5.4 min, p=0.015), median ICU stay (26 vs 37 days, p=0.004), and complication rate (6.4% vs 25.8%, p=0.038) were found to be significantly lower in group FOB. While the 28-day mortality in the entire study group was 17.7% (n=11), there was no significant difference between the groups (p=0.740). Conclusion: In PDT procedures performed under FOB guidance, procedure time, length of stay in the ICU, and procedure-related complication rates were significantly lower, while no significant difference was observed in terms of mortality.

PERCUTANEOUS DILATATIONAL TRACHEOSTOMY IN COVID-19 PATIENTS IN THE COVID HOSPITAL INTENSIVE CARE UNIT: THE UNIVERSITY CLINICAL CENTER OF VOJVODINA EXPERIENCE.

Patients with acute respiratory distress syndrome due to COVID-19 require intensive care unit (ICU) admission with consecutive endotracheal intubation and invasive mechanical ventilation. In patients with long-term mechanical ventilation, percutaneous dilatational tracheostomy (PDT) may be considered. This retrospective analysis includes clinical data on patients treated at the ICUs of the COVID Hospital of the Clinical Center of Vojvodina in the period from September 3, 2021 to May 1, 2022, and underwent PDT. Patients were predominantly male (n=48; 65.8%). Weaning from mechanical ventilation was achieved in 31 (42.5%) and decannulation in 25 (34.2%) patients. The mean time from polymerase chain reaction SARS CoV-2 positivity until PDT was 15.59±6.85 days. The mean time of endotracheal intubation before the PDT procedure was 7.37±4.89 days. The mean weaning time from mechanical ventilation was 10.45±7.92 days. Twenty-five (34.2%) patients were decannulated at the mean time of 19.60±11.81 days. The complications were tracheostomy related bleeding (2 patients), pneumothorax (4 patients), subcutaneous emphysema (1 patient) and cricoid cartilage injury (1 patient). PDT is a simple, safe, and effective procedure performed in COVID-19 patients in the ICU.

Percutaneous dilatational tracheostomy: evaluation of YouTube videos.

In today's rapidly changing world, the technology of social media is widely used for educational purposes. Our aim in this study was to investigate the accuracy and efficacy of video presentations of percutaneous dilatational tracheostomy procedures available on the international video sharing website YouTube. On 1 December 2020, the terms "percutaneous dilatational tracheostomy" and "percutaneous tracheostomy" were entered into the search feature of YouTube ( www.youtube.com ). The evaluation was made in three categories; general information about percutaneous tracheostomy, performing percutaneous tracheostomy steps and demographic features of videos. The median number of viewings of the videos on the date our data were collected was 1342 (IQR, 237-8052), and the most watched video had been viewed 325,170times. Surgical site cleaning was explained in46 (65.7%) videos and incision site detection in55 (78.6%) videos. Needle aspiration into the trachea, insertion of the Seldinger guidewire, dilatation, and tracheal tube placement were covered in all videos (70; 100%). Confirmation of the location of the tracheal tube with end tidal capnography, the last step of the procedure, is available in 34videos (48.6%). The use of inexpensive or freely available teaching materials is possible but should always be checked before use with respect to the completeness and correctness of the content conveyed. The unreflected adoption of such content can lead to serious treatment errors.

Yoğun Bakım Ünitemizde Perkütan Dilatasyonel Trakeostomi Açılan Hastaların Retrospektif Analizi

INTRODUCTION: Tracheostomy is a method frequently applied in intensive care units with the indication of prolonged intubation. [1] Our aim in this study is to retrospectively analyze the percutaneous dilatational tracheostomy (PDT) cases performed in our clinic within 1 year.
 METHODS: It's analyzed the patients who underwent PDT in Sakarya Training and Research Hospital, Anesthesia Intensive Care Unit between January 2019 and December 2019. Each patient's age, gender, diagnosis of intensive care admission, use of anticoagulant drugs, and APACHE II score were recorded. Then, the day of tracheostomy procedure, complications, total intensive care unit stay, and the patient's discharge from the intensive care unit were evaluated.
 RESULTS: A total of 79 patients were found to have undergone PDT. It was observed that the mean age of the patients was 66.56±17.83 and 48 (60.8%) were male. It was observed that 25(31.6%) of the patients were admitted to the intensive care unit with the diagnosis of postresuscitation syndrome, 17 (21.5%) cerebrovascular accident, and 15(19%) pneumonia. The mean APACHE II scores of the patients were 24.1±6.2, and 16(20.3%) patients were discharged. The median PDT procedure day was 19.5[12-30]. It was determined that only 2 of the patients had minor and 1 major and 3 (3.9%) patients did not develop any other complications apart from the bleeding related complication.
 DISCUSSION AND CONCLUSION: In our study, although 66 (83.6%) of the patients who underwent PDT procedure received anticoagulant-antiaggregant treatment, postoperative bleeding rates were observed to be quite low in accordance with the literature.

Is HFJV a better alternative ventilation technique for percutaneous dilatational tracheostomy? A randomized trial.

High-frequency jet ventilation (HFJV) has been used for the treatment of tracheal lesions, airway surgery, and treatment of secondary lesions after tracheostomy for many years however, reports on the use of HFJV during percutaneous dilatational tracheostomy (PDT) are limited. This study compares the use of traditional method, ventilation with laryngeal mask airway (LMA), and HFJV through endotracheal tube (ETT) with respect to the duration of PDT procedure and complications. Seventy-five patients were randomized into one of the three groups with computer-generated random numbers: Group ETT (N.=25), group LMA (N.=25), and group HFJV (n=25). Demographic data, duration of PDT, complications such as ETT cuff puncture and tube transaction, accidental extubation, difficult cannula insertion, bleeding, desaturation during the procedure, arterial blood gases immediately before and after the procedure have been recorded. Mean time for successful PDT in group ETT was 5.9±1.35 minutes, in group LMA 4.96±0.78 minutes, and 3.88±0.78 minutes in group HFJV. PDT duration was shorter in the LMA group than in the ETT group (P<0.05). In the HFJV group, the PDT duration was shorter than the LMA group (P<0.05) and the ETT group (P<0.001). In terms of the total number of complications, significantly fewer complications were observed in the HFJV group compared with group ETT and group LMA. HFJV may be a more effective alternative method for airway management during PDT, facilitating and reducing the duration of the intervention.

Use of ProSeal Laringeal Mask Airway Under Bronchoscopy Guidance During Percutaneous Dilatational Tracheostomy

Objective: In the current study, our primary aim is to compare complication rates between using ProSeal laryngeal mask airway (P-LMA) and endotracheal tube (ETT) in bronchoscopy-guided percutaneous dilatational tracheostomy (PDT) procedure. Our secondary aim is to compare the processing time of these two techniques. Methods: Sixty-one adult patients who were intubated in the intensive care unit and scheduled for PDT due to the need for long-term mechanical ventilation were included in the study. The patients were randomly divided into ETT group or P-LMA group under bronchoscopy guidance. Complications related to the procedures and the duration of each procedure were recorded. Hemodynamic measurements, oxygen saturation, arterial blood gas analysis, preferred mechanical ventilation mode, positive end expiratory pressure and mean airway pressure values were recorded before PDT, and 30 minutes after the procedure. Results: A total of 61 cases, 23 (38%) female and 38 (62%) male, participated in the study. Regarding the complication rates between the groups, we encountered more complications in the ETT group and the most common complication was puncture of the cuff of the intubation tube. The procedure time was also significantly shorter in the P-LMA group (P-LMA; 2.5 min, ETT; 3.6 min). Conclusion: Using P-LMA for PDT under bronchoscopy caused lower complication rate than using ETT. In a addition the duration of PDT procedure was shorter in P-LMA group than ETT group. Keywords: Percutaneous dilatational tracheostomy, bronchoscopy, laryngeal mask

Safely performing percutaneous dilatational tracheostomies on COVID-19 patients in the intensive care unit: A standardized approach.

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and the resulting coronavirus disease 2019 (COVID‐19) have afflicted hundreds of millions of people in a worldwide pandemic. During this pandemic, otolaryngologists have sought to better understand risk factors associated with COVID‐19 contamination during surgical procedures involving the airways such as tracheostomies.ObjectiveThis study provides a standardized technique of performing an ultrasound (US)‐guided percutaneous dilatational tracheostomy (PDT) on COVID‐19 patients in the intensive care unit (ICU). It also outlines safety strategies for health care providers that includes proper use of personal protective equipment (PPE) and regular testing of otolaryngologists for COVID‐19 contamination.MethodsThis study analyzed data from 44 PDT procedures performed on COVID‐19 patients in the ICU of hospitals in Sao Paulo and Santos, Brazil. The PDT procedures were conducted between April 2020 and August 2020, which coincided with a peak of the COVID‐19 pandemic in São Paulo, Brazil. Surgeons were tested for COVID‐19 using a two‐stage serological enzyme‐linked immunosorbent assay specific for SARS‐CoV‐2 antigens.ConclusionThis study describes a safe standardized technique of US‐guided PDT for COVID‐19 patients in the ICU using a method that also decreases the risk of surgeon contamination.

Outcomes and Timing of Bedside Percutaneous Tracheostomy of COVID-19 Patients over a Year in the Intensive Care Unit.

Background: The benefits and timing of percutaneous dilatational tracheostomy (PDT) in Intensive Care Unit (ICU) COVID-19 patients are still controversial. PDT is considered a high-risk procedure for the transmission of SARS-CoV-2 to healthcare workers (HCWs). The present study analyzed the optimal timing of PDT, the clinical outcomes of patients undergoing PDT, and the safety of HCWs performing PDT. Methods: Of the 133 COVID-19 patients who underwent PDT in our ICU from 1 April 2020 to 31 March 2021, 13 patients were excluded, and 120 patients were enrolled. A trained medical team was dedicated to the PDT procedure. Demographic, clinical history, and outcome data were collected. Patients who underwent PDT were stratified into two groups: an early group (PDT ≤ 12 days after orotracheal intubation (OTI) and a late group (>12 days after OTI). An HCW surveillance program was also performed. Results: The early group included 61 patients and the late group included 59 patients. The early group patients had a shorter ICU length of stay and fewer days of mechanical ventilation than the late group (p < 0.001). On day 7 after tracheostomy, early group patients required fewer intravenous anesthetic drugs and experienced an improvement of the ventilation parameters PaO2/FiO2 ratio, PEEP, and FiO2 (p < 0.001). No difference in the case fatality ratio between the two groups was observed. No SARS-CoV-2 infections were reported in the HCWs performing the PDTs. Conclusions: PDT was safe and effective for COVID-19 patients since it improved respiratory support parameters, reduced ICU length of stay and duration of mechanical ventilation, and optimized the weaning process. The procedure was safe for all HCWs involved in the dedicated medical team. The development of standardized early PDT protocols should be implemented, and PDT could be considered a first-line approach in ICU COVID-19 patients requiring prolonged mechanical ventilation.

Percutaneous dilatational tracheostomy in patients with mechanical circulatory support: Is the procedure safe?

We aimed to investigate the efficacy and safety of percutaneous dilatational tracheostomy procedure following cardiac surgery in patients receiving extracorporeal membrane oxygenation and/or left ventricular assist device. A total of 42 patients (10 males, 32 females; mean age 51±14.6 years; range, 18 to 77 years) who underwent percutaneous dilatational tracheostomy procedure under extracorporeal membrane oxygenation and/or left ventricular assist device support between January 2017 and January 2019 were retrospectively analyzed. Laboratory data, Simplified Acute Physiology Score-II and Sequential Organ Failure Assessment scores, and major and minor complications were recorded. The 30-day and one-year follow-up outcomes of the patients were reviewed. Of 42 patients, 17 (42.5%), 14 (33.3%), and 11 (26.2%) received left ventricular assist device, extracorporeal membrane oxygenation, and extracorporeal membrane oxygenation + left ventricular assist device, respectively. During percutaneous dilatational tracheostomy, the laboratory values of the patients were as follows: international normalized ratio, 2.3±0.9; partial thromboplastin time, 59.4±19.5 sec; platelet count, 139.2±65.8×109/L, hemoglobin, 8.8±1.0 g/dL, and creatinine, 1.6±1.0 mg/dL. No peri-procedural mortality, major complication, or bleeding was observed. We observed minor complications including localized stomal ooze in four patients (8.3%) and local stomal infection in three patients (6.2%). Our study results suggest that percutaneous dilatational tracheostomy is an effective and safe technique in this patient population.

Can biochemical biomarkers predict mortality in percutaneous dilatational tracheostomies?

Aim: The aim of this retrospective study was to explore the possibility of using biochemical parameters as biomarkers in predicting mortality in patients undergoing percutaneous dilatational tracheostomy (PDT) where the prognosis may be fatal. Material and Method: The patients’ demographic features, early complications, days in the intensive care unit and mortality rates were recorded. Additionally, data obtained from venous blood samples taken 1 day prior to and 1 day following the PDT procedure were noted, neutrophil-to-lymphocyte ratios (NLR) and platelet-to-lymphocyte ratios (PLR) were assessed. Patients were divided into 2 groups: the survivor group (those who underwent PDT and were discharged from the hospital after treatment, n=20) and the non-survivor (patients who underwent PDT but died at the hospital after treatment, n=67).Results: A significant difference was found between the groups in terms of a number of days in intensive care (p=0.006), preoperative neutrophil count (p=0.041) and postoperative NLR (p=0.041). Differences were seen in the pre- and postoperative blood parameters of the patients in the non-survivor group in terms of lymphocyte count (p&amp;lt;0.001), Mean Platelet Volume (MPV) (p=0.002) and PLR (p&amp;lt;0.001) values. The results of the correlation analysis revealed a positive correlation between the prognosis and the neutrophil count (p=0.040) and between the prognosis and post-PDT NLR (p=0.040), but a negative correlation between the prognosis and duration of the hospital stay (p=0.005). ROC curve analysis showed that only the post-PDT NLR value, indicating 68.7% sensitivity and 60.0% specificity over the 6.91 cut-off point, could be a specific and sensitive biomedical marker and predictor of a prognosis that would end in mortality.Conclusion: As a result of this pilot study, it can be argued that the NLR level measured post-PDT can be a prognostic biomarker in predicting the risk of mortality for patients undergoing PDT.

Severe pain-related adverse events of percutaneous dilatational tracheostomy performed by a neurointensivist compared with conventional surgical tracheostomy in neurocritically ill patients

BackgroundWe evaluated severe pain-related adverse events (SAE) during the percutaneous dilatational tracheostomy (PDT) procedure performed by a neurointensivist and compared the outcomes with that of conventional surgical tracheostomy in neurocritically ill patients.MethodsThis was a retrospective and observational study of adult patients who were admitted to the neurosurgical intensive care unit between January 2014 and March 2018 and underwent tracheostomy. In this study, primary endpoints were incidence of SAE: cardiac arrest, arrhythmias, hypertension, hypotension, desaturation, bradypnea, or ventilatory distress. The secondary endpoint was procedure-induced complications.ResultsA total of 156 patients underwent tracheostomy during the study. Elective surgery of brain tumors (34.0%) and intracranial hemorrhage (20.5%) were the most common reasons for admission. The most common reasons for tracheostomy were difficult ventilator weaning or prolonged intubation (42.9%) and sedative reduction (23.7%). Tachycardia (30.1%) and hypertension (30.1%) were the most common SAE. Incidence of SAE was more common in conventional tracheostomy compared to PDT (67.1% vs. 42.3%, P = 0.002). The total duration of SAE (19.8 ± 23.0 min vs. 3.4 ± 5.3 min, P < 0.001) and procedural time (42.2 ± 21.8 min vs. 17.7 ± 9.2 min, P < 0.001) were longer in conventional tracheostomy compared to PDT. Multivariable adjustment revealed that only PDT by a neurointensivist significantly reduced the incidence of SAE by one third (adjusted odds ratio [OR]: 0.36, 95% confidence interval [CI]: 0.187–0.691). In addition, PDT by a neurointensivist deceased the duration of SAE by 8.64 min (β: -8.64, 95% CI: − 15.070 – -2.205, P = 0.009) and prolonging the procedure time by every one minute significantly increased the duration of SAE by 6.38 min (β: 6.38, 95% CI: 0.166–0.470, P < 0.001). Procedure-induced complications were more common in conventional tracheostomy compared to PDT (23.5% vs. 11.3%, P = 0.047).ConclusionsThis retrospective and exploratory study of our single-center limited cohort of tracheostomy patients revealed that decreased SAE may be associated with short procedural time during the PDT procedure performed by a neurointensivist. It is proposed that PDT by a neurointensivist may be safe and feasible in neurocritically ill patients.

A Successful Percutaneous Dilatational Tracheostomy Procedure in Pneumonectomized Patient: A Case Report

Tuberculosis (TB) continues to be a substantial cause of morbidity and the current approach to TB treatment is medical chemotherapy. However the most common benign cause of pneumonectomy is still pulmonary tuberculosis and after pneumonectomy mediastinal structures could be displaced resulting airway obstruction. The tracheostomy procedure is recommended for ventilator dependent patients Percutaneous dilatational tracheostomy (PDT) mostly replaced surgical one due to its simplicity and cost effectiveness.

The Effect of Flexible Lightwand and Ultrasonography Combination on Complications of the Percutaneous Dilatational Tracheostomy Procedure.

The aim of this study was to evaluate the effect of the flexible lightwand and ultrasonography (USG) combination on reducing the complications in percutaneous dilatational tracheostomy (PDT) opened with the forceps dilatation method. A retrospective examination was made of 138 patients between January 2014 and December 2018. Before starting to process, the anatomic structures of the patients were visualized with USG and the tracheostomy area was marked. Sedation and local anesthesia were applied to patients before the procedure, then the percutaneous tracheostomy was performed using the Griggs technique after confirmation of the tracheostomy localization defined with USG using the transillumination method with a flexible lightwand within an endotracheal tube. Complications that developed associated with the procedure were recorded. The mean age of the patients was 59.1±22.0 years and the mean length of stay in the intensive care unit was 42.3±35.5 days (range, 11-207 days). Overall, complications developed in 22 (15.6%) patients, of which 10.7% were early complications (1.4% related to the tube, 5.8% minor and 3.5% major complications). Tube- related complications were seen to develop in two patients. In the evaluation of the early minor complications, the most frequently seen complication was minor bleeding in 5.8% of the patients. No major vessel bleeding was determined in any patient in the early or late period. Of the late complications, the infection was seen to develop in four (2.8%) patients and stenosis in three (2.1%). The combination of flexible lightwand and USG in the PDT procedure minimized tube-related complications and contributed to the prevention of bleeding complications.

Assessment of the percutaneous dilatational tracheostomy technique in experimental manikins and canine cadavers.

To evaluate procedure time, ease of placement, and complication rates of percutaneous dilatational tracheostomy (PDT) compared to surgical tracheostomy (ST) in canine cadavers. Randomized crossover experimental manikin and cadaver study involving 6 novice veterinary students. University teaching hospital. Canine tracheostomy training manikin, 24 canine cadavers. None. For training, each student performed 10 PDT and 10 ST procedures on a training manikin, followed by 2 PDT and 2 ST procedures on a canine cadaver. After each training procedure, feedback from bronchoscopy and observers was provided. Final PDT and ST tube placements using new equipment were performed in unused cadavers. Placements were timed, ease of placement was scored using visual analog scales (VAS, 0-10 cm), and complications were assessed by two independent observers using ordinal scales (0-3). Cadaver tracheas were explanted postprocedure to evaluate anatomical damage scores (0-3). Procedure time and VAS scores for PDT and ST procedures were analyzed using mixed-effects linear models, accounting for student, technique, and procedure number with post hoc pairwise comparisons. Data are presented as median (range). For the final cadaver placement, there were no significant differences in placement time (300 seconds [230-1020] vs 188 seconds [116-414], P = 0.210), ease of placement (3.8 cm [2.1-5.7] vs 1.9 cm [0-4.7], P = 0.132), anatomical damage score (1 [0-2] vs 0 [0-1], P = 0.063), or equipment complications score (0 [0-1] vs 0 [0-0], P = 1.000) between PDT and ST, respectively. These data suggest that PDT can be performed as quickly, as easily, and as safely as ST in a canine cadaver by novice veterinary students following manikin training. Additional studies will be required to determine if these findings can be translated into veterinary clinical practice.

Cost Comparison of Single-Use Versus Reusable Bronchoscopes Used for Percutaneous Dilatational Tracheostomy.

BackgroundBoth single-use and reusable bronchoscopes are suitable for percutaneous dilatational tracheostomy (PDT) to visualise the trachea during the insertion process. To determine the least costly option, the price of single-use bronchoscopes must be weighed against the estimated average cost of a bronchoscopy with reusable equipment. In the latter case, the acquisition cost must be spread over the equipment’s useful life and other relevant costs, such as reprocessing and repair, must be included.ObjectiveThis study aimed to calculate the cost of using single-use or reusable bronchoscopes per PDT procedure.MethodsA systematic literature search was conducted to identify studies comparing the costs of reusable and single-use bronchoscopes for PDT. Inclusion criteria were articles assessing the cost of single-use or reusable bronchoscopes, and where costs were divided into acquisition, reprocessing, and repair costs. A questionnaire regarding repair rates and costs for reusable bronchoscopes was sent to 366 hospitals in the US, UK, and Germany to supplement the identified literature.ResultsEleven studies met the inclusion criteria. Ninety-nine completed responses were received, of which 31 hospitals used reusable equipment for PDT. Literature research revealed an average acquisition cost of $US135 (SD 152) and reprocessing cost of $US123 (SD 128). Additionally, a combination of data from the literature and the questionnaires gave a repair cost per use of $US148 (SD 242), resulting in a total average cost of $US406 for reusable bronchoscopes and $US249 (SD 36) for single-use bronchoscopes per PDT procedure. Thus, the incremental cost per use of a reusable bronchoscope compared with a single-use bronchoscope was $US157.ConclusionsWe conclude that significant savings can be made by using single-use bronchoscopes to guide PDT in preference to reusable bronchoscopes. Results depend on hospital setting, the reprocessing procedures, annual bronchoscope procedures, individual repair cost, and repair rates.Electronic supplementary materialThe online version of this article (10.1007/s41669-018-0091-2) contains supplementary material, which is available to authorized users.

The percutaneous dilatational tracheostomy in the intensive care unit - our experience

Percutaneous tracheostomy is a commonly carried out procedure in patients in the Intensive Care Unit. Percutaneous dilatational tracheostomy consists of the introduction of a tracheal cannula from the front of the neck, through blunt dissection of the pretracheal tissues, using a guide by Seldinger technique. When percutaneous dilatational tracheostomy procedure was introduced in routine clinical practice in the Clinical Center of Vojvodina, procedural protocol was established. This Protocol includes: 1. indications, contraindications and timing for percutaneous dilatational tracheostomy, 2. assessment of the patient, 3. preparation of the patient and equipment, 4. procedure description, 5. potential complications and complication management. At our institution percutaneous dilatational tracheostomy is performed on an individual patient basis assessment within 5-7 days following translaryngeal intubation. Routinely the platelet count, activated prothrombin time and prothrombin time are checked. The patient?s neck is assessed clinicaly and by the use of fiberoptic bronchoscope and ultrasound. At our institution we use the modified Ciaglia technique of the percutaneous dilatational tracheostomy-Ciaglia Single Dilatator method with the TRACOE? experc Set vario which includes spiral rein?forced tracheal cannula. At the end of procedure fiberoptic evaluation of the tracheobroinchial tree is made and chest X-ray is done. Percutaneous dilatational tracheostomy is a simple, safe, and effective procedure performed in the Intensive Care Unit. It is the preferred technique of airway management in the Intensive Care Units in the patients requiring prolonged mechanical ventilation, tracheobronchial hygiene and weaning from mechanical ventilation.

BILATERAL PNEUMOTHORAX AS A COMPLICATION OF PERCUTANEOUS TRACHEOSTOMY: CASE REPORT

Percutaneous dilatational tracheostomy is a common surgical procedure that is becoming the method of choice in critically ill patients whenever prolonged airway secure and/or ventilation support is needed. Although adverse events are relatively uncommon, serious life threatening complications can arise from this bedside procedure. We report a case of a 70-year-old female who developed extensive subcutaneous emphysema and bilateral pneumothorax immediately after a percutaneous dilatational tracheostomy procedure. Different mechanisms, such as damage to posterior or anterior tracheal wall, false passage or paratracheal placement or dislocation of the cannula are considered to be responsible for the development of pneumothorax and subcutaneous emphysema. Although bronchoscopic control after the tracheostomy procedure did not reveal any tracheal injury, we believe that subcutaneous emphysema and bilateral pneumothorax are most likely caused by procedure induced injuries of the trachea in addition to the applied high airway pressure induced by excessive or inappropriate ventilation. In our case report, we would like to emphasize that continuous bronchoscopic guidance during percutaneous tracheostomy is invaluable in decreasing the incidence of its overall complications, especially during enhancing the team experience.

A Novel, Adaptable Laryngeal Mask to Facilitate a Percutaneous Dilatational Tracheostomy: Proof-of-Concept Prototype Demonstration on a Mannequin Model and Cadaver.

Most percutaneous dilatational tracheostomy (PDT) mortalities result from airway-related complications. Improved airway pressure management and gas delivery are targets for innovation. This study describes an adaptable laryngeal mask (ALM) designed to remove the bronchoscope from the endotracheal tube (ETT) and place it in a separate lumen. Airflow and device efficacy were evaluated during PDTs with an ALM on mannequins and cadavers, respectively. Procedures were completed by a single physician using an 8.0 mm ETT and the Ciaglia Blue Rhino method on simulation mannequins (TruCorp AirSim Traci) and fresh-frozen cadavers. Mannequin simulation tested the respiratory capabilities of an ALM utilizing a BioPac spirometer and a Maquet Servo ventilator. Qualitative analysis on device efficacy was performed on 2 fresh-frozen cadavers (1 male, 1 female). Preliminary ventilation testing on a PDT-able mannequin using the ALM showed an increase in airflow reaching the lungs compared with a deflated ETT. During mannequin and cadaver testing, the ALM was placed over the in situ ETT effectively, thereby removing the bronchoscope from the ETT while maintaining a continuous visual of the incision site. Both mannequin and cadaveric testing using an ALM enabled a single physician to safely perform the PDT procedure with minimal assistance. Initial testing using an ALM during PDT on mannequins and cadavers showed an improvement in airflow and the removal of the bronchoscope from the ETT, respectively. Further studies using the ALM in a patient population compared with standard techniques would be useful.