Tracheostomy under jet-ventilation - An alternative approach to ventilating patients undergoing surgically created or percutaneous dilational tracheostomy

ABSTRACT

In a prospective observational study we compared the results of 297 elective tracheostomies under jet-ventilation with regard to its complication rate and practicability. Of those, 156 patients underwent surgically created tracheostomy [SCT] and 141 patients percutaneous dilational tracheostomy [PDT]. Initially, in 159 patients jet-ventilation was performed using a jet- cannula inserted intratracheally through the cricothyroid membrane. In the remaining 138 patients the jet-ventilator was connected to the endoscopic instrument channel [2,2 mm ID, 4,9 mm OD, 600 mm Length] and ventilation via the fiberoptic bronchoscope [FB-15x, Pentax Europe GmbH, Hamburg] was applied manually. With jet-ventilation, oxygenation was maintained throughout the procedure as long as the tracheal puncture was successful und jet-cannula fixed in place. The bronchoscope-guided gas stream, when compared to jet-cannula inserted intratracheally, offered more space for tracheostomy and safety for the patient. The permanent danger of mishappenings and dislocation involved with the jet-cannula could be avoided, since the bronchoscope was operating on under direct visualization. Under these circumstances, PDT is an acceptable approach to inserting a tracheostomy tube under jet- ventilation via bronchoscope, particularly for the management of difficult airway in critically ill patients