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78th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

16.05. - 20.05.2007, Munich

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The use of the Tracheotomy Endoscope (TED) with Percutaneous Dilatational Tracheotomies (PDT) in Intensive Care Medicine, results of a pilot study

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  • corresponding author Eckard Klemm - Dresden-Friedrichstadt Hospital, Department of Otorhinolaryngology, Dresden, Germany
  • author Andreas Nowak - Dresden-Friedrichstdt Hospital, Department of Anesthesiology and Intensive Care Medicine, Dresden, Germany

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 78th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Munich, 16.-20.05.2007. Düsseldorf, Köln: German Medical Science; 2007. Doc07hno022

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/hno2007/07hno022.shtml

Published: August 8, 2007

© 2007 Klemm et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Introduction: Numerous observations to heavy peri-operative complications of PDT (posterior wall injuries, heavy bleeding, pneumothorax, tracheal ring fractures) [1] demands an improved management of PDT. First results of a pilot study with TED [2] are presented.

Method: The TED was used under continous respiratory gas monitoring with 23 critical ill patients (5 female, 18 male, on the average 65 years old) during long-term mechanical ventilation (on the average 10 days) in the methods CIAGLIA (Blue Rhino) 13x, FROVA (Percu Twist) 6x, FANTONI (TLT) 2x, GRIGGS (GWDF) 2x.

Results:

1.
Introduction of the endoscope along the endotracheal tube was always without any problems.
2.
Cricoid cartilage and the second through fourth tracheal rings have been clearly identified from inside view in all cases.
3.
Optimal puncture site was marked by transillumination with the curved ligth carrier inserted through the endoscope.
4.
The projecting posterior lip of the tracheotomy endoscope prevented inadvertent punctures of the posterior tracheal wall.
5.
Counterpressure from the rigid endoscope greatly reduces the pressure exerted on the trachea during dilatation. The endoscope allows effective ventilation to be maintained throughout the tracheotomy procedure.
6.
Displaced fracture fragments of tracheal rings were immediatly removed endoscopically in eight cases.
7.
Critical oxigenation, critical hypercapnia or strong bleedings never occurred.
8.
Video tracheoscopy during PDT was helpful for a more steeply learning curve.

Conclusions: These pilot study confirm expectations that risk reduction is possible during PDT using TED. Further analyses are necessary.

Outline

References

1.
Gründling M, Kuhn SO, Pavlovic W, Wendt M. Tracheotomy past and present. International Symposium 11.-13. May 2006. J An Ints. 2006;13:1-96.
2.
Klemm E. Dilatational tracheostomy using the KLEMM Tracheotomy Endoscope Endo-Press. Tuttlingen; 2006.