Acute Crit Care.  2018 May;33(2):89-94. 10.4266/acc.2017.00563.

Feasibility of Percutaneous Dilatational Tracheostomy with a Light Source in the Surgical Intensive Care Unit

• Baek JK
• Lee JS
• Kang M
• Choi NJ
• Hong SK

• KMID: 2436316
• DOI: http://doi.org/10.4266/acc.2017.00563

Abstract

BACKGROUND
Although percutaneous dilatational tracheostomy (PDT) under bronchoscopic guidance is feasible in the intensive care unit (ICU), it requires extensive equipment and specialists. The present study evaluated the feasibility of performing PDT with a light source in the surgical ICU.
METHODS
The study involved a retrospective review of the outcomes of patients who underwent PDT with a light source performed by a surgery resident under the supervision of a surgical intensivist in the surgical ICU from October 2015 through September 2016. During the procedure, a light wand was inserted into the endotracheal tube after skin incision. Then, the light wand and the endotracheal tube were pulled out slightly, the passage of light through the airway was confirmed, and the relevant point was punctured.
RESULTS
Fifty patients underwent PDT with a light source. The average procedural duration was 14.0 ± 7.0 minutes. There were no procedure-associated deaths. Intraoperative complications included minor bleeding in three patients (6%) and paratracheal placement of the tracheostomy tube in one patient (2%); these were immediately resolved by the surgical intensivist. Two patients required conversion to surgical tracheostomy because of the difficulty in light wand insertion into the endotracheal tube and a very narrow trachea, respectively.
CONCLUSIONS
PDT with a light source can be performed without bronchoscopy and does not require expensive equipment and specialist intervention in the surgical ICU. It can be safely performed by a surgical intensivist with experience in surgical tracheostomy.

Keyword

intensive care units; light wand; percutaneous dilatational tracheostomy

MeSH Terms

Bronchoscopy
Critical Care*
Hemorrhage
Humans
Intensive Care Units
Intraoperative Complications
Organization and Administration
Retrospective Studies
Skin
Specialization
Trachea
Tracheostomy*

Figure

• 

  Figure 1. (A) The light wand. (B) Light source located at the tip of endotracheal tube.

• 

  Figure 2. Visualization of the trachea. During the procedure, transillumination of the light source helps visualize and puncture the trachea more accurately than tactile sense alone.

Reference

References

1. Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy. A new simple bedside procedure: preliminary report. Chest. 1985; 87:715–9.

2. Johnson-Obaseki S, Veljkovic A, Javidnia H. Complication rates of open surgical versus percutaneous tracheostomy in critically ill patients. Laryngoscope. 2016; 126:2459–67.

3. Hinerman R, Alvarez F, Keller CA. Outcome of bedside percutaneous tracheostomy with bronchoscopic guidance. Intensive Care Med. 2000; 26:1850–6.

4. Beiderlinden M, Karl Walz M, Sander A, Groeben H, Peters J. Complications of bronchoscopically guided percutaneous dilational tracheostomy: beyond the learning curve. Intensive Care Med. 2002; 28:59–62.

5. Freeman BD, Isabella K, Cobb JP, Boyle WA 3rd, Schmieg RE Jr, Kolleff MH, et al. A prospective, randomized study comparing percutaneous with surgical tracheostomy in critically ill patients. Crit Care Med. 2001; 29:926–30.

6. Putensen C, Theuerkauf N, Guenther U, Vargas M, Pelosi P. Percutaneous and surgical tracheostomy in critically ill adult patients: a meta-analysis. Crit Care. 2014; 18:544.

7. Delaney A, Bagshaw SM, Nalos M. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis. Crit Care. 2006; 10:R55.

8. Guinot PG, Zogheib E, Petiot S, Marienne JP, Guerin AM, Monet P, et al. Ultrasound-guided percutaneous tracheostomy in critically ill obese patients. Crit Care. 2012; 16:R40.

9. Rudas M, Seppelt I, Herkes R, Hislop R, Rajbhandari D, Weisbrodt L. Traditional landmark versus ultrasound guided tracheal puncture during percutaneous dilatational tracheostomy in adult intensive care patients: a randomised controlled trial. Crit Care. 2014; 18:514.

10. Raimondi N, Vial MR, Calleja J, Quintero A, Cortés A, Celis E, et al. Evidence-based guidelines for the use of tracheostomy in critically ill patients. J Crit Care. 2017; 38:304–18.

11. Addas BM, Howes WJ, Hung OR. Light-guided tracheal puncture for percutaneous tracheostomy. Can J Anaesth. 2000; 47:919–22.

12. Gobatto AL, Besen BA, Tierno PF, Mendes PV, Cadamuro F, Joelsons D, et al. Comparison between ultrasound- and bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients: a retrospective cohort study. J Crit Care. 2015; 30:220. e13-7.

13. Gobatto AL, Besen BA, Tierno PF, Mendes PV, Cadamuro F, Joelsons D, et al. Ultrasound-guided percutaneous dilational tracheostomy versus bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients (TRACHUS): a randomized noninferiority controlled trial. Intensive Care Med. 2016; 42:342–51.