Percutaneous Dilatational Tracheostomy Research Articles

Percutaneous dilatational tracheostomy in patients with head and neck tumors: literature review and institutional experience

Introduction. Patients with head and neck tumors are often require tracheostomy. This procedure represents complex surgical manipulation and is associated with risk of certain complications, including life-threatening. The study objective is to essess the results of percutaneous tracheostomy with the new SafeTrach technique. Materials and methods. The study included 21 patients. All patients had a tracheostomy performed using the SafeTrach technique. Results. Mean duration of tracheostomy with SafeTrach technique was 11.8 ± 3.4 minutes independently of patients’ body mass index or previous treatment (correlation coefficients r = 0.08, p = 0.7 and r = 0.08, p = 0.73, respectively). Among all possible complications of tracheostomy only 1 (4.7 %) case of bleeding in postoperative period was noted in our study. Conclusion. The SafeTrach technique combines all the benefits of open and percutaneous tracheostomy. It is characterized by simplicity, it does not require endoscopic control, that indicates the feasibility of its widespread implementation.

Percutaneous dilational tracheostomy: current techniques and evidence of safety

Tracheostomy has transitioned from being the complete domain of surgeons, as described by Chevalier Jackson in early 20th century, to a procedure shared by intensivists and interventional pulmonologists in form of percutaneous dilatational tracheostomy. This procedure is commonly performed in intensive care units to facilitate long-term mechanical ventilation for chronic respiratory failure, but other less frequent indications also exist. The commonly practiced techniques for percutaneous dilational tracheostomy rely on passage of tools over a guidewire, with the Ciaglia technique being the most popular and having the best safety profile. Adjunctive techniques include use of bronchoscopy, bedside ultrasonography, and laryngeal mask airway (LMA). In properly selected patients, percutaneous dilational tracheostomy carries a good safety profile, but some patient characteristics may increase the risk of complications; thus, the procedure is complimentary to surgical tracheostomy (ST) and not a complete replacement. Bedside ultrasound and bronchoscopy are routinely available instruments in most intensive care units, although there is limited evidence of improved safety with these adjuncts. In properly selected patients, percutaneous dilational tracheostomy can be a safe and cost-effective alternative to ST.

Percutaneous dilatational tracheostomy: A prospective analysis among ICU patients

Background: Percutaneous dilatational tracheostomy (PDT) is a simple bedside procedure, particularly useful in intensive care units. Over the last few decades, the technique of PDT has gained popularity due to its comparable safety to the more surgical tracheostomy (ST). Objective: To describe the outcome of PDT using modified Ciaglia’s technique in patients of Surgical ICU. Methodology: This was a prospective cohort study that analyzed the outcomes of PDTs carried out on critically ill patients admitted in the surgical ICU, Pakistan Institute of Medical Sciences, Islamabad from August 2015 to January 2017. All PDTs were performed by the presiding consultant and his team using modified Ciaglia’s (Blue Rhino) technique. The main outcome was the frequency of perioperative and early complications within the first six days. Demographic variables and complications were recorded. Data was analyzed using SPSS version 18. Results: Seventy-four patients underwent PDTs in the surgical ICU with the mean age of the patients was 49.17 ± 12.82 years. The commonest indication of tracheostomy was prolonged mechanical ventilation followed by failure to wean. Complications rate was 12.16% of which perioperative bleeding occurred in 6.7% of patients. Early complications within the first six days were wound infection, tube displacement and blocked tube. Conclusion: PDT is a valuable, efficacious and safe method that can be performed at the bedside with minimal complication rate and needs to be considered more frequently in the intensive care units in developing countries. Keywords: Percutaneous Dilatational Tracheostomy, Complications, Intensive Care Unit.

Outcomes after percutaneous dilatation tracheostomy: Patients view 6years after the procedure.

Percutaneous dilatational tracheostomy have been performed increasingly since its introduction in 1985, and is today one of the most commonly performed operative procedures in intensive care units. The aim of this study was to document patient-reported outcomes from percutaneous dilatational tracheostomy after hospital discharge. This study is based on retrospective extraction of data from the databases in the ICU at Haukeland University Hospital from 2004 to 2016. Patients alive by April 2018 and with a code for dilatation tracheostomy were sent a questionnaire about their experiences with having a tracheostomy performed. The occurrence of problems and their relations were registered. Of 5769 admitted patients, 900 patients ≥15years (15.7%) had a percutaneous dilatation tracheostomy performed. The median time from admission to follow-up was 6.1years, and the 30days mortality in those who received a tracheostomy was 315/900 (35%). Of the 441 survivors contacted, 181 answered the questionnaire and a total of 293 problems were reported. The majority of these problems were reported as no or moderate in 115 patients (78.3%). The presence of any problem was significantly associated with occurrence for other problems; however, there were no significant differences related to the elapsed time since the ICU stay. Pain and difficulties with breathing were the two single factors most often related to occurrence of other problems. Although self-reported problems after percutaneous tracheostomy occurring after hospital discharge were often reported, most (78.3%) were considered by the patients to be moderate.

Bronchoscopy Guided V.S Ultrasound Guided Percutaneous Tracheostomy

Abstract Introduction Percutaneous dilatational tracheostomy (PDT) is a widely utilized technique in the intensive care unit as it is a safe and cost effective technique. Bronchoscopy guided percutaneous dilatational tracheostomy has traditionally been used as a safety adjunctive tool in order to define the appropriate site for the tracheal puncture, to guide the real-time entrance of the needle into the trachea, avoiding tracheal posterior wall injuries, and confirming the endotracheal tube placement. By contrast, bronchoscopy might not precisely identify the cervical anatomical structures. Ultrasound has emerged as potentially useful tool in assisting percutaneous dilatational tracheostomy when factors that increase the technical difficulty of the procedure (morbid obesity, difficult anatomy & cervical spine precautions) are present. Several studies have demonstrated the value of pre-procedure cervical ultrasound in order to improve the safety of percutaneous dilatational tracheostomy. Objectives This review aimed at comparing bronchoscopy guided versus ultrasound guided percutaneous tracheostomy in terms of the detected complications resulting from each procedure. Design A randomized prospective comparative trial. Setting Critical care department, Ain Shams university hospital. Patients Forty adult patients, requiring elective PDT, and need to maintain a secure airway. Methods They were randomly assigned to 2 groups; fiber optic bronchoscopy PDT group I and Ultrasound guided PDT group II. Both groups used Blue Rhino technique for PDT. Post-operative complications were recorded. Results In group I, males were 11(55%) and females were 9(45%) while in group II, males and females were 14(70%) and 6(30%) respectively. Age in group I ranged from 37-67 with mean value of 52.4±10.89 and in group II ranged from 40-71 with mean value of 54.6±9.81. There was one puncture in 19 cases (95%) in group I, while one puncture in 17 cases (85%) in group II. Total time in group I was ranged from 3-9 with mean value 5.3±1.69 and in group II was ranged from 3-9 with mean value 6.2±1.79. Transient hypoxemia occurs in about 3 cases (15%) in the bronchoscopy guided PDT group in comparison to none in the ultrasound guided PCT group. Bleeding occurred in 2 patients (10%) in bronchoscopy guided PDT group versus one patient (5%) in Ultrasound guided PCT group. Misplacement of the tracheostomy tube was encountered in only two cases (10%) in US guided PDT group and non in the other bronchoscopy guided PDT group, which lead subsequently to pneumothorax in one case (5%). Conclusion Percutaneous dilatational tracheostomy is a bedside safe procedure with low rate of complications. US guided PDT and bronchoscopy guided PDT are effective, safe and associated with similar complication rate and clinical outcome. Bronchoscopy guidance during PDT offers the best vision decreasing the need for multiple punctures and the risk of misdirection or false passage of the tube. Ultrasound is a promising less invasive method to guide the percutaneous tracheostomy procedure.

Comparison of the efficacy of surgical tracheostomy and percutaneous dilatational tracheostomy with flexible lightwand and ultrasonography in geriatric intensive care patients.

To compare the applicability, technical difficulties and postoperative complications of surgical tracheostomy and percutaneous dilatational tracheostomy with the flexible lightwand + ultrasonography method applied because of prolonged intubation to geriatric patients in the intensive care unit. A retrospective evaluation was made of 76 patients who received surgical tracheostomy (group 1) and 78 patients who received percutaneous dilatational tracheostomy (group 2). The patients were evaluated in respect of demographic data, duration of intubation, length of stay in the intensive care unit and discharge status, and after the intervention, the development of tube-related complications, early stage local complications and late-stage complications. The time from intubation to tracheostomy was determined as 22.73 ± 15.23 days in group 1 and 12.65 ± 7.64 days in group 2. The mortality rate of patients in group 1 was determined to be statistically significantly higher than that of group 2 (P = 0.048). When evaluated in respect to early and late complications, nine early- and seven late-stage complications developed in group 1, and three early- and three late-stage complications developed in group 2 (P = 0.05). In the evaluation of factors related to mortality, the time from intubation to tracheostomy (r = 0.249, P = 0.01) and the presence of a comorbidity (r = 0.325, P = 0.004) were determined to have a positive correlation with the development of mortality. Percutaneous dilatational tracheostomy with the flexible lightwand + ultrasonography technique is a safe, rapid and effective method with the advantage of management in respect to early complications, such as bleeding, and can be used safely in the geriatric patient population in intensive care conditions. Geriatr Gerontol Int 2020; ••: ••-••.

Predictors of difficulty in bedside percutaneous dilatational tracheostomy: pilot study.

percutaneous dilatational tracheostomy is currently one of the main procedures performed in an intensive care unit (ICU). However, there are no well-defined indicators of technical difficulty in performing the procedure. to define predictors of difficulty in performing bedside percutaneous dilatational tracheostomy. prospective cohort study encompassing 21 patients who underwent bedside percutaneous dilatational tracheostomy in the ICU at a single center. Sternohyoid (SH) distance shorter than 7 cm is associated with a 50% increase in the risk of technical difficulty (OR 0.44 and p <0.03). the reduction in (SH) distance is related to an increased risk of difficulty in performing percutaneous dilatational tracheostomy in the ICU bed.

Percutaneous dilatation tracheostomy at liver transplantation intensive care unit by surgeons

Aim: Tracheostomy has evolved to be a routine procedure for prolonged mechanical ventilation patients in the intensive care unit. We aimed to analyze retrospectively our patients underwent percutaneous dilatation tracheostomy due to prolonged mechanical ventilation following liver transplantation.Material and Methods: Data of 34 patients who underwent percutaneous dilatation tracheostomy by general surgeons due to prolonged mechanical ventilation following liver transplantation were analyzed and evaluated retrospectively.Results: Patients did not experience any complications except minor bleeding following liver transplantation. Besides this technique facilitated patient compliance as well as comfort, which were essential during an accurate weaning process.Conclusion: Percutaneous dilatation tracheostomy is a safe method due to its low complication rate and easy applicability in hands of surgeons who are familiar with the neck anatomy.

Per-cutaneous dilatation tracheostomy (PCTD) in COVID-19 patients and peri-tracheostomy care: A case series and guidelines.

Background & Objective:COVID 19 patients with severe respiratory failure may require prolonged mechanical ventilation. Placement of a tracheostomy tube often becomes necessary for such patients. The steps of tracheostomy procedure and post tracheostomy care of these patients can be classified as aerosol generating. We wish to highlight our modified technique to address these issues.Methodology:We performed percutaneous dilation tracheostomy in three clinically challenging COVID-19 patients in our ICU and developed guidelines aiming to minimise aerosolisation during and after the tracheostomy procedure to safeguard healthcare workers.Results:Percutaneous tracheostomy was performed by a team of three experienced anaesthetists and an ICU nurse.Conclusion:The decision of surgical or percutaneous tracheostomy should be dependent on the experience of the tracheostomy performer, health-care worker safety, resource availability, and patient-centred care. We believe our modified strategic approach of brief bronchoscopy, minimum PEEP and gas flows and step-wise planned approach for PCDT offers an extra level of safety to healthcare workers.

Introducing a new instrument "Downpipe endotracheal tube" for improving the safety of percutaneous dilatational tracheostomy.

Background:Percutaneous dilatational tracheostomy (PDT) is the most commonly used minimally invasive procedure in patients with prolonged mechanical ventilation. However, during the procedure withdrawal, the endotracheal tube (ET) may cause substantial gas leak and sometimes the airway could be lost, and the patient exposed to severe hypoxemia. In order to prevent hypoxemia during ET withdrawal and needle stuck in ET during PDT and also for performing the procedure more safe and easy.Material and Methods:In this study, we introduce a new instrument “downpipe endotracheal tube” that has been registered as a patent and examined it in eight patients to confirm practical advantage of this tube.Results:These patients were five female and three male, with a mean weight of 71.7 kg and the mean age of 65.12 years. The cause of tracheostomy was difficult weaning from mechanical ventilation.Conclusion:The procedure was safe in all cases. We did not find any complications during the procedure.

The Comparative Changes in Inflammatory Markers Between Fiber Optic Bronchoscopy Guided and Classical Percutaneous Dilatational Tracheostomy

The Comparative Changes in Inflammatory Markers Between Fiber Optic Bronchoscopy Guided and Classical Percutaneous Dilatational Tracheostomy

Ciaglia ve Griggs' Perkutanöz Dialatasyonel Trakeostomi Yöntemlerinin Karşılaştırması: Hangisi Daha Etkili ve Güvenli?

Ciaglia ve Griggs' Perkutanöz Dialatasyonel Trakeostomi Yöntemlerinin Karşılaştırması: Hangisi Daha Etkili ve Güvenli?

Comparative Analysis of Frequency and Structure of Complications after Various Options of Tracheostomy

The article presents a new technique developed by RSCS named after acad. V. Vakhidov for performing percutaneous dilatational tracheostomy by using the improved Howard-Kelly forceps, which ensures stable traction of the guidewire and reduces the risk of trauma to surrounding tissues. In order to assess the feasibility and necessity of carrying out a modified method of tracheostomy, a comparative analysis of the frequency and structure of complications after various options for tracheostomy was carried out, taking into account the presence or absence of risk factors for an adverse outcome.

Percutaneous Dilatational Tracheostomy and Modifications in Intensive Care Unit Patients

Percutaneous dilatational tracheostomy (PDT) is a commonly performed procedure in critically ill patients [1]. It can be safely performed bedside. This has resulted in decline in the use of surgical tracheostomy except in few selected cases. Over the last 10 years data on newer methods of insertion, timing, safety profile and complication rates has been published, which has greatly improved our understanding of this procedure [2]. The most common indication of tracheostomy in the ICU is the need for prolonged ventilation. Less complication occur with an increase in skills. Many methods of performing PDT have been discovered recently [3]. Bronchoscopy has been found to be beneficial procedural aides the PDT [4]. In our study, a brief overview about the use of PDT in ICU and, different percutaneous techniques will be discussed. The conclusion is that percutaneous tracheostomies offer benefits for some of the outcomes when compared with surgical tracheostomies.

Application Value of Minimally Invasive Percutaneous Dilational Tracheostomy for ICU Critical Patients.

Objective:To find out the application value of minimally invasive percutaneous dilational tracheostomy in critically ill patients in intensive care unit (ICU).Methods:One hundred and forty critically ill patients who underwent tracheostomy in ICU of our hospital were included in the study from August 2016 to December 2017. They were divided into an observation group and a control group by random number table method, 70 in each group. The control group received conventional tracheotomy, while the observation group received percutaneous dilational tracheostomy. The operation time, incision length, amount of intraoperative bleeding and healing time of incision were compared between the two groups, and the changes of vital signs and complications after operation were recorded. The family members of the patients signed the informed consent.Results:The operation time, healing time and incision length of the observation group were (9.92±4.13) min, (1.31±0.21) cm and (6.91±0.72) d respectively, shorter than (24.09±6.82) min, (3.40±0.65) cm and (67.48±0.61) d in the control group, and the differences were statistically significant (P<0.05). The amount of intraoperative bleeding of the observation group was (7.81±1.83) mL, less than (16.34±2.83) mL in the control group; the difference was statistically significant (P<0.05). The heart rate and oxygen saturation of the observation group before and during the operation were not significantly different (P>0.05). The heart rate of the control group during the operation was significantly higher than that before the operation (P<0.05); the oxygen saturation of the control group before and during the operation had no significant difference (P>0.05). The incidence of complications in the observation group was 24.3%, which was significantly lower than that in the control group (55.7%, X2=8.279, P=0.014).Conclusion:Minimally invasive percutaneous dilational tracheostomy has advantages of small trauma, less infection and beautiful incision, and it will not increase postoperative complications. It is of great value in the treatment of ICU critical patients.

Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations.

Background and AimCritically ill patients on mechanical ventilation undergo tracheostomy to facilitate weaning. The practice in India may be different from the rest of the world and therefore, in order to understand this, ISCCM conducted a multicentric observational study “DIlatational percutaneous vs Surgical tracheoStomy in intEnsive Care uniT: A practice pattern observational multicenter study (DISSECT Study)” followed by an ISCCM Expert Panel committee meeting to formulate Practice recommendations pertinent to Indian ICUs.Materials and methodsAll existing International guidelines on the topic, various randomized controlled trials, meta-analysis, systematic reviews, retrospective studies were taken into account to formulate the guidelines. Wherever Indian data was not available, international data was analysed. A modified Grade system was followed for grading the recommendation.ResultsAfter analyzing the entire available data, the recommendations were made by the grading system agreed by the Expert Panel. The recommendations took into account the indications and contraindications of tracheostomy; effect of timing of tracheostomy on incidence of ventilator associated pneumonia, ICU length of stay, ventilator free days & Mortality; comparison of surgical and percutaneous dilatational tracheostomy (PDT) in terms of incidence of complications and cost to the patient; Comparison of various techniques of PDT; Use of fiberoptic bronchoscope and ultrasound in PDT; experience of the operator and qualification; certain special conditions like coagulopathy and morbid obesity.ConclusionThis document presents the first Indian recommendations on tracheostomy in adult critically ill patients based on the practices of the country. These guidelines are expected to improve the safety and extend the indications of tracheostomy in critically ill patients.How to cite this articleGupta S, Dixit S, Choudhry D, Govil D, Mishra RC, Samavedam S, Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations. Indian J Crit Care Med 2020;24(Suppl 1):S31–S42.

Design and Evaluation of a Low-Cost Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy Simulator

Bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT) is an invasive procedure regularly performed in the intensive care unit. Risk of serious complications have been estimated in up to 5%, focused during the learning phase. We have not found any published formal training protocols, and commercial simulators are costly and not widely available in some countries. The objective of this study was to present the design and simulator performance of a low-cost BG-PDT simulator. A simulator was designed with materials available in a hardware store, synthetic skin pads, ex vivo bovine tracheas, and a pipe inspection camera. The simulator was tested in 8 experts and 9 novices. Sessions were video recorded, and participants were equipped with the Imperial College Surgical Device, a hand motion-tracking device. Performance was evaluated with a multimodal approach, including first attempt success rate, global success rate, total procedural time, Imperial College Surgical Device-derived proficiency parameters, and global rating scale applied blindly by 2 expert observers. A satisfaction survey was applied after the procedure. A simulator was successfully constructed, allowing multiple iterations per assembly, with a fixed cost of US $30 and $4 per use. Experts had greater global and first attempt success rate, performed the procedure faster, and with greater proficiency. It presented high user satisfaction and fidelity. A low-cost BG-PDT simulator was successfully constructed, with the ability to discriminate between experts and novices, and with high fidelity. Considering its ease of construction and cost, it can be replicated in almost any intensive care unit.

Evaluation of the Safety of Percutaneous Dilational Tracheostomy Compared with Surgical Tracheostomy in the Intensive Care Unit.

Background Tracheostomy is a necessary procedure for patients who require long-term mechanical ventilation support. There are two methods for tracheostomy in current use: surgical tracheostomy (ST) and percutaneous dilational tracheostomy (PDT). In the current study, we retrospectively compared the safety of both procedures performed in our intensive care unit (ICU). Methods In this study, we enrolled subjects who underwent tracheostomy in our ICU between January 2012 and March 2016. We excluded subjects who were <20 years old and underwent tracheostomy in the operating room. As a primary outcome, we evaluated the rate of complications between ST and PDT groups. The length of ICU stay, time to tracheostomy from intubation, and the rate of mechanical ventilation and mortality at 28 postoperative days were also examined as secondary outcomes. Results Compared with the ST group, the rate of all complications was lower in the PDT group (13.4% vs. 38.8%, p=0.007). Although the rate of intraoperative complications did not differ between the two groups (3.8% vs. 8.1%, p=0.62), relative to the ST procedure, the PDT procedure was associated with fewer postoperative complications (34.6% vs. 9.6%, p=0.003). Among postoperative complications, accidental removal of the tracheostomy tube and an air leak from the tracheostomy fistula were less frequent in the PDT group than the ST group. Between the two groups, there were no significant differences in their secondary outcomes. Conclusion This retrospective study indicates that relative to ST, PDT is a safer procedure to be performed in the ICU. Fewer postoperative complications following PDT might be attributed to the small skin incision made during this procedure.

Ultrasound Guidance and Flexible Fiberoptic Bronchoscopy Guidance in Percutaneous Dilatational Tracheostomy

Ultrasound Guidance and Flexible Fiberoptic Bronchoscopy Guidance in Percutaneous Dilatational Tracheostomy

Antiplatelet agents and anticoagulants increased the bleeding risk of bedside percutaneous dilational tracheostomy in critically ill patients

The main objective of this study was to investigate the safety of bedside percutaneous dilational tracheostomy (PDT) by pulmonologists in critically ill patients, and the factors associated with complications resulting from PDT. We retrospectively enrolled critically ill patients who had undergone bedside PDT in the intensive care units (ICUs) and respiratory care center from February 2016 to December 2018. A total of 312 patients were included for analysis, with a mean age of 69.6±17.7 years. Two hundred and eight of the patients were male (66.7%). The mean acute physiology and chronic health evaluation II score was 25.3±6.3, and the mean body mass index was 22.4±4.2. Most of the patients were intubated due to respiratory disorders (51.3%). Fifty-six patients (17.9%) received antiplatelet agents or an anticoagulant regularly prior to PDT. All enrolled patients were undergone bedside PDT successfully. The total complication rate of PDT was 14.4%. Patients who took antiplatelet agents or anticoagulants regularly before PDT had a higher risk of bleeding than patients who went without (26.8% versus 7.0%, adjusted odds ratio 4.93 [95% f 2.16-11.25], p<0.001). Finally, a longer length of intubation resulted in a higher probability in the length of ICU stay being ≧28 days (adjusted odds ratio 1.11 [95% CI 1.08-1.14], p<0.001). Our study demonstrated that it was feasible for pulmonologists to perform bedside PDT in critically ill patients. However, antiplatelet agents and anticoagulants use increased the risk of bleeding in PDT patients.