gms | German Medical Science

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