Article
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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Published: | August 8, 2007 |
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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.