Optimal methodology for percutaneous dilatational tracheostomy: a comparative analysis between conventional and multidisciplinary approaches utilizing ultrasound, flexible bronchoscopy, and microcatheter puncture in critically ill individuals of diminutive stature-a longitudinal single-institutional experience and retrospective analysis.

Background: Percutaneous dilatational tracheostomy (PDT), a bedside procedure in intensive care, enhances respiratory support for critically ill patients with benefits over traditional tracheostomy, such as improved safety, ease of use, cost-effectiveness, and operational efficiency by eliminating patient transfers to the operating room. It also minimizes complications including bleeding, infection, and inflammation. Despite decades of PDT evolution and device diversification, adaptations primarily cater to larger Western patients rather than smaller-statured Korean populations. This study assesses the efficacy and appropriateness of the Ciaglia Blue Rhino (Cook Critical Care, Bloomington, IN, USA), augmented with ultrasound, flexible bronchoscopy, and microcatheter techniques, for Korean patients with short stature. Methods: We conducted PDT on 183 intubated adults (128 male/55 female) with severe respiratory issues at a single medical center from January 2010 to December 2022. Patients were divided into two groups for retrospective analysis: a modified group (n=133) underwent PDT with ultrasound-guided flexible bronchoscopy and microcatheter puncture, and a conventional group (n=50) received PDT using only the Ciaglia Blue Rhino device. We assessed clinical and demographic characteristics, outcomes, and complications such as pneumothorax and emphysema. The study also evaluated the suitability and effectiveness of the devices for Korean patients with short stature. Results: Demographic characteristics including sex, body weight, height, body mass index, obesity status, and underlying diseases showed no significant differences between the two groups. However, the modified group was older (69.5±14.2 vs. 63.5±14.1 years; P=0.01). The sequential organ failure assessment (SOFA) and simplified acute physiology score (SAPS) II score was slightly higher in the modified groups, but no statistically significant differences were observed (7.1±2.3 vs. 6.7±2.3, P=0.31 and 46.7±9.0 vs. 44.0±9.1, P=0.08, respectively). The duration of hospital and ICU stays, as well as days post-PDT, were longer in the conventional group, yet these differences were not statistically significant (P=0.20, P=0.44, P=0.06). Total surgical time, including preparation, ultrasound, bronchoscopy, and microcatheter puncture, was significantly longer in the modified group (25.6±7.5 vs. 19.9±6.5 minutes; P<0.001), and the success rate of the first tracheal puncture was also higher (100.0% vs. 92.0%; P=0.006). Intra-operative bleeding was less frequent in the modified group (P=0.02 for tracheostomy site bleeding and P=0.002 for minor bleeding). Conclusions: PDT, performed at the bedside in intensive care settings, proves to be a swift and dependable method. Utilizing the Ciaglia Blue Rhino device, combined with ultrasound guidance, flexible bronchoscopy, and 4.0-Fr microcatheter puncture, PDT is especially effective for intubated patients who cannot be weaned from ventilation. This technique results in fewer complications than traditional tracheostomy and is particularly beneficial for patients with respiratory issues and smaller-statured Koreans, potentially reducing morbidity and mortality.

Evaluation of the Effect of Morphological Structure on Dilatational Tracheostomy Interference Location and Complications with Ultrasonography and Fiberoptic Bronchoscopy.

Background: Percutaneous dilatational tracheostomy (PDT) is the most commonly performed minimally invasive intensive care unit procedure worldwide. Methods: This study evaluated the percentage of consistency between the entry site observed with fiberoptic bronchoscopy (FOB) and the prediction for the PDT level based on pre-procedural ultrasonography (USG) in PDT procedures performed using the forceps dilatation method. The effect of morphological features on intervention sites was also investigated. Complications that occurred during and after the procedure, as well as the duration, site, and quantity of the procedures, were recorded. Results: Data obtained from a total of 91 patients were analyzed. In 57 patients (62.6%), the USG-estimated tracheal puncture level was consistent with the intercartilaginous space observed by FOB, while in 34 patients (37.4%), there was a discrepancy between these two methods. According to Bland Altman, the agreement between the tracheal spaces determined by USG and FOB was close. Regression formulas for PDT procedures defining the intercartilaginous puncture level based on morphologic measurements of the patients were created. The most common complication related to PDT was cartilage fracture (17.6%), which was proven to be predicted with maximum relevance by punctured tracheal level, neck extension limitation, and procedure duration. Conclusions: In PDT procedures using the forceps dilatation method, the prediction of the PDT intervention level based on pre-procedural USG was considerably in accordance with the entry site observed by FOB. The intercartilaginous puncture level could be estimated based on morphological measurements.

Can't intubate, can't oxygenate? What is the preferred surgical strategy? A retrospective analysis.

INTRODUCTION: Cricothyrotomy (CTM) is currently recommended as the preferred method due to its ease, speed, and safety in life-threatening airway emergencies where standard tracheal intubation and mask ventilation fail. MATERIAL AND METHODS: This retrospective study analyzed 33 cases of "can't intubate, can't oxygenate or ventilate" (CICOV): 12 of percutaneous dilatational tracheostomy (PDT) and 21 of CTM. The CTM group was younger (median age 44) and mainly consisted of trauma patients. The PDT group was more diverse and procedures were performed by anesthesia and critical care consultants. RESULTS: Initial success rates were 100% for PDT (12/12) and 86% for CTM (18/21), with one conversion from CTM to PDT. No perioperative complications occurred in the PDT group, while the CTM group experienced two cases of false tracts requiring re-do and three cases of bleeding. Immediate mortality within 24 hours was reported in 5/19 CTM patients and none in the PDT group. Successful liberation from mechanical ventilation at hospital discharge was achieved in 6/12 PDT patients and 11/21 CTM patients. Among the 21 CTM cases, all 16 survivors underwent subsequent tracheostomy. Tracheal decannulation occurred in 4/12 PDT patients and 10/21 CTM patients. Favorable immediate neurological outcomes (GCS ≥ 11T) were observed in 8/12 PDT patients and 8/21 CTM patients, while 3 PDT patients remained anesthetized until death and 7 CTM patients died within the first 72 hours without recovery attempts. CONCLUSIONS: In experienced hands, PDT could be a legitimate clinical option for the surgical airway in cases of CICOV. CTM may be more suitable for practitioners who encounter CICOV infrequently.

Comparing Simulation Training of Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy Using Conventional Versus 3D Printed Simulators (TRAC-Sim Study).

Background: Individual implementation rate of bronchoscopy-guided percutaneous dilatational tracheostomy (PDT) varies among intensivists. Simulation training (ST) can increase the safety of medical procedures by reducing stress levels of the performing team. The aim of this study was to evaluate the benefit of ST in PDT regarding procedural time, quality of performance, and percepted feelings of safety of the proceduralist and to compare conventional simulators (CSIM) with simulators generated from 3D printers (3DSIM). Methods: We conducted a prospective, single-center, randomized, blinded cross-over study comparing the benefit of CSIM versus 3DSIM for ST of PDT. Participants underwent a standardized theoretical training and were randomized to ST with CSIM (group A) or 3DSIM (group B). After ST, participants' performance was assessed by two blinded examiners on a porcine trachea regarding time required for successful completion of PDT and correct performance (assessed by a performance score). Percepted feelings of safety were assessed before and after ST. This was followed by a second training and second assessment of the same aspects with crossed groups. Results: 44 participants were included: 24 initially trained with CSIM (group A) and 20 with 3DSIM (group B). Correctness of the PDT performance increased significantly in group B (p < .01) and not significantly in group A (p = .14). Mean procedural time required for performing a PDT after their second ST compared to the first assessment (p < .01) was lower with no difference between group A and group B and irrespective of the participants' previous experience regarding PDT, age, and sex. Moreover, percepted feelings of safety increased after the first ST in both groups (p < .001). Conclusions: ST can improve procedural skills, procedural time, and percepted feelings of safety of the proceduralist in simulated PDT.

Appropriate Endotracheal Tube Position for Percutaneous Dilatational Tracheostomy: A Single-Center Observational Study.

Aim This study aimed to investigate the appropriate endotracheal tube (ETT) position during percutaneous dilatational tracheostomy (PDT). Methods This single-center observational study included hospitalized patients who underwent surgical tracheostomy (ST) between August 2021 and October 2022. During ST, the trachea was opened, and the ETT was pulled out visually. It stopped when the ETT was no longer visible, and the tracheostomy tube was placed in the trachea. The ETT position was measured by considering the ETT position during ST to be the appropriate position during PDT. The correlation between the measured ETT position and patient characteristics was evaluated. A prediction equation for the ETT position was derived from the derivation group, and validation of the prediction equation was evaluated by the validation group. Results Forty-six and 15 patients were in the derivation and validation groups, respectively. Weight, duration of intubation, and in-hospital mortality were significantly different between the two groups. The measured ETT position correlated with body height (r=0.60, p<0.001) and sex (r=0.45, p=0.002), while the ETT position before ST showed a weak correlation (r=0.34, p=0.020). The predicted and measured values in the validation group correlated with each other (r=0.58, p=0.024). Conclusion The appropriate ETT position for PDT correlates with body height, and the equation "body height×0.112-0.323 cm" was derived. This predictive equation may be useful as a guide for ETT positioning during PDT puncture.

Effect of open surgical and percutaneous dilatational tracheostomy on postoperative wound complications in patients: A meta-analysis.

Tracheostomy is one of the most common operations. The two main methods of tracheostomy are open surgical tracheostomy (OST) and percutaneous dilatational tracheostomy (PDT). In critical cases, the combination of these two approaches is especially crucial, with the possibility of successful outcomes and low complications. Thus, the purpose of this system is to analyse the effects of both methods on the outcome of postoperative wound. In this research, we performed a systematic review of Cochrane Library, PubMed, Web of Science and Embase, to determine all randomized controlled trials (RCTs) that are comparable in terms of postoperative injury outcomes. Eleven RCTs were found after screening. This study will take the necessary data from the selected trials and evaluate the documentation for RCTs. PDT was associated with a lower incidence of infection at the wound site than OST (OR, 4.46; 95% CI: 2.84-7.02 p < 0.0001), and PDT decreased blood loss (OR, 2.88; 95% CI: 1.62-5.12 p = 0.0003). But the operation time did not differ significantly in both PDT to OST (MD, 4.65; 95% CI: -1.19-10.48 p = 0.12). The meta-analyses will assist physicians in selecting the best operative procedure for critical cases of tracheostomy. These data can serve as guidelines for clinical management and in the design of future randomized, controlled studies.

A Modified Technique for Percutaneous Dilatational Tracheostomy.

Purpose: Percutaneous dilatational tracheostomy (PDT) is widely used in mechanical ventilation patients to facilitate weaning. This modified technique aims to reduce accidental intraprocedural airway loss and desaturation associated with current PDT techniques. Materials and Methods: This is a single-center, prospective cohort study of 100 patients who underwent a modified technique between September 8, 2022, and January 18, 2023. The procedure was performed at Shiraz University of medical science at the tertiary center, Namazi teaching hospital. In this method instead of withdrawing the endotracheal tube (ETT) up close to the vocal cord and subglottic area at the beginning of the procedure, which is a common theme in PDT techniques with accidental extubation risk, we kept the ETT and gradually withdraw it. Results: Of the 100 patients, the average age was 53.5 years, and 66% were males. On average, the procedure lasted 255 (67) seconds. All patients successfully underwent PDT with no life-threatening complications, accidental intraprocedural airway loss, or desaturation. Conclusions: As a result of this modified technique, PDT for airway management can be a safe and low-complication procedure without the risk of accidental intraprocedural airway loss. Moreover, omitting bronchoscopy and sonography during these procedures is cost-effective and secure.

Comparative Study of Percutaneous Dilatational Tracheostomy and Conventional Surgical Tracheostomy in Critically Ill Adult Patients.

The present study was aimed to compare percutaneous dilatational tracheostomy (PDT) with that of conventional surgical tracheostomy (ST) in critically ill adult patients requiring tracheostomy for respiratory management. For this purpose 32 critically ill patients, admitted to the ICU between July 2016 and June 2018, were subjected to tracheostomy and randomly divided into two groups (PDT and ST) of 16 patients each. Mean duration of intubation was similar between the two procedures while the mean size of the tracheostomy tube was smaller in percutaneous technique. In comparison, post-operative infection after 7 days seem to be statistically lowered and the length of scar tend to be smaller in PDT patients. Although early and late post-operative complication rates are not statistically significant in the PDT groups, yet investigations of the long-term outcome following PDT are, therefore, necessary. Generally, PDT has lower acute complications than ST, although this may vary by the specific PDT technique. Patient factor may also influence complications. In view of the benefit versus risks in tracheostomy, PDT may be considered the "procedure of choice" for performing elective tracheostomies in critically ill adult patients.

The Importance of Early Percutaneous Dilatational Tracheostomy in Inhalation Injury: A Case Report.

Maintaining a patent airway is critical for treating patients with severe inhalation injuries. Percutaneous Dilatational Tracheostomy (PDT) has been used effectively for many patients treated in the Intensive Care Unit (ICU). In addition to its safety for use at the bedside, according to Friedman et al. PDT has the same or even lower complication rate than surgical tracheostomy. PDT can be performed in a shorter time and is more cost-effective. Herein, we report a 44 year old obese woman who sustained an inhalation injury related to a burn. The patient fell headfirst into a pot of boiling water at the time of the burn. The patient showed signs of inhalation injury and suffered a second-to-third degree burn injury. She was treated in the ICU, and early PDT was performed. The procedure was performed by first locating the trachea, followed by a 1-cm incision made between the second and third tracheal ring. She was intubated successfully and treated in the ICU for 7 days. The anesthesiologist chose to perform an early PDT to prevent further complications. This procedure was done successfully despite many comorbidities from the patient, such as being an obese female and having a short neck, which makes finding the exact location for the incision challenging. In this case, the early decision to proceed with PDT showed promising results in decreasing the patient's mortality risk.

Tracheostomy Outcomes on Trauma Patients.

Objective: Tracheostomies are performed in trauma patients for multiple purposes. Approaches to the procedure are usually directed by individual expertise and local preferences. Though generally safe, a tracheostomy can cause serious complications. This study aims to identify complications associated with tracheostomies performed at the level I Trauma Center of the Puerto Rico Medical Center (PRMC) to have an advanced foundation to develop and implement guidelines to improve patient outcomes. Study Design: A retrospective cross-sectional study. Setting: Level I Trauma Center of the PRMC. Methods: Medical charts of 113 trauma adult patients that underwent tracheostomy at the PRMC from 2018 to 2020 were reviewed. Data collected included patient demographics, surgical approach, initial tracheostomy tube size (ITTS), intubation period, and flexible laryngoscopic findings. Complications occurring during and after tracheostomy were documented. The unadjusted relationship of the independent variables and outcome measures was assessed using χ 2 and Fisher's test for categorical variables and the Wilcoxon-Mann-Whitney rank-sum test for continuous ones. Results: Abnormal airway findings detected on flexible laryngoscopic examination were reported in 30 patients in the open tracheostomy (OT) group and 43 patients in the percutaneous tracheostomy group (p = 0.007). Peristomal granulation tissue was reported in 10 patients with an ITTS 8, while in only 1 patient with an ITTS 6 (p = 0.026). Conclusion: This study showed several key findings in our cohort. The OT surgical approach was associated with fewer long-term complications when compared to the percutaneous approach. Also, a statistically significant difference in peristomal granulation tissue findings was found between the ITTS, ITTS-6 and ITTS-8, the smaller size being associated with fewer abnormal findings.

[Role of anthropometric parameters in percutaneous tracheostomies performed on cadavers]. / Az antropometriai paraméterek szerepe a cadaveren végzett percutan tracheostomás módszerekben.

INTRODUCTION AND OBJECTIVE: For patients requiring prolonged mechanical ventilation, tracheostomy becomes necessary, which may be performed through surgical or percutaneous methods. In this study, we used three different methods of percutaneous dilatational tracheostomy. Our goal was to identify anthropometric parameters relevant for the correct position of the tracheostomy tube. MATERIAL AND METHODS: Randomized, controlled observational study was performed on 118 cadavers. Three different tracheostomy methods were used: the Griggs (n = 37), the Griggs modified by Élo (n = 45), and the Ciaglia's Blue Rhino (n = 36). The neck circumference, jugulomental distance, and mid-upper arm circumference were measured on each cadaver. We assessed whether the aforementioned parameters related with the appropriate positioning of the tracheostomy tube Results: Significant correlation was found (p = 0.0287) between mid-upper arm circumference and incorrect tracheostomy tube position (below the fourth tracheal cartilage ring). We identified the value of 30 cm of mid-upper arm circumference as the ideal cut-off for predicting tube malposition (sensitivity: 63.63%, specificity: 60.22%). CONCLUSION: When planning percutaneous tracheostomy, it is important to measure the anthropometric parameters. If mid-upper arm circumference is 30 cm or higher we recommend other tests and/or ENT (ear, nose, and throat) consultation. Orv Hetil. 2023; 164(16): 630-635.

Fiberoptic Bronchoscope-guided vs Mini-surgical Technique of Percutaneous Dilatational Tracheostomy in Intensive Care Units: A Comment.

How to cite this article: Bandyopadhyay A, Puri S, Ashok V. Fiberoptic Bronchoscope-guided vs Mini-surgical Technique of Percutaneous Dilatational Tracheostomy in Intensive Care Units: A Comment. Indian J Crit Care Med 2023;27(1):78.

Percutaneous dilatation tracheotomy in patients on extracorporeal membrane oxygenation after cardiac surgery.

BACKGROUND: Current practices regarding percutaneous dilatational tracheostomy in adult patients treated with extracorporeal membrane oxygenation (ECMO) after cardiac surgery is not completely defined. This study aimed to evaluate the safety of the percutaneous dilatational tracheostomy in patients with ECMO after cardiac surgery. METHODS: Between July 2017 and May 2021, 371 ECMO procedures were performed in more than 35,000 adult patients who underwent cardiac surgery in our hospital. Sixty-two patients underwent percutaneous dilatational tracheostomy (PDT) during or after ECMO. A retrospective analysis was performed comparing the incidence of complications and clinical outcomes of the two groups. RESULTS: Of the 371 patients treated with ECMO after adult cardiac surgery during the enrollment period, 22 (7.1%) and 40 (12.8%) underwent PDT during or after ECMO, respectively. The platelet count (PLT) of the day was significantly lower in the PDT during ECMO group (54 (34, 68) vs. 108 (69, 162) (thousands), p < 0.001)). The prothrombin time (PT) and activated partial thromboplastin time (APTT) of the day were longer in the PDT during ECMO group (15.8 (14.6, 19.9) vs. 13.8 (13.2, 15.2) seconds, p = 0.001, 43.8 (38.0, 49.4) vs. 35.2 (28.2, 40.9) seconds, p < 0.001, respectively). There was no significant difference in tracheotomy-related complications between the two groups. Significantly decreased ventilator time was observed in the PDT during ECMO group. CONCLUSIONS: Despite poor coagulation of the day, PDT during ECMO is safe and can appropriately reduce the duration of mechanical ventilation compared with PDT after ECMO weaning in adult patients who have undergone cardiac surgery.

PERCUTANEOUS DILATATIONAL TRACHEOSTOMY IN COVID-19 PATIENTS IN THE COVID HOSPITAL INTENSIVE CARE UNIT: THE UNIVERSITY CLINICAL CENTER OF VOJVODINA EXPERIENCE.

Patients with acute respiratory distress syndrome due to COVID-19 require intensive care unit (ICU) admission with consecutive endotracheal intubation and invasive mechanical ventilation. In patients with long-term mechanical ventilation, percutaneous dilatational tracheostomy (PDT) may be considered. This retrospective analysis includes clinical data on patients treated at the ICUs of the COVID Hospital of the Clinical Center of Vojvodina in the period from September 3, 2021 to May 1, 2022, and underwent PDT. Patients were predominantly male (n=48; 65.8%). Weaning from mechanical ventilation was achieved in 31 (42.5%) and decannulation in 25 (34.2%) patients. The mean time from polymerase chain reaction SARS CoV-2 positivity until PDT was 15.59±6.85 days. The mean time of endotracheal intubation before the PDT procedure was 7.37±4.89 days. The mean weaning time from mechanical ventilation was 10.45±7.92 days. Twenty-five (34.2%) patients were decannulated at the mean time of 19.60±11.81 days. The complications were tracheostomy related bleeding (2 patients), pneumothorax (4 patients), subcutaneous emphysema (1 patient) and cricoid cartilage injury (1 patient). PDT is a simple, safe, and effective procedure performed in COVID-19 patients in the ICU.

Comparison of landmark guided and ultrasound guided percutaneous dilatational tracheostomy: Efficiency, efficacy and accuracy in critically ill patients.

Background and Aims: To overcome the procedure-related complications associated with landmark-guided percutaneous dilatational tracheostomy (PDT) ultrasound is emerging as a promising tool. Present study was designed to compare landmark-guided PDT and ultrasound-guided PDT in terms of efficiency, efficacy, and accuracy. Material and Methods: Hundred intensive care unit patients requiring prolonged mechanical ventilation were prospectively randomized into 2 groups of 50 patients each. In land mark guided (LMG) group, patients underwent landmark-guided PDT, whereas in ultrasound guided (USG) group, patients underwent ultrasound-guided PDT. Results: Both the groups were comparable in terms of demographic data, sequential organ failure assessment score, ventilator settings, and mean days on mechanical ventilation prior to PDT. The mean assessment time in the ultrasound-guided group (1.56 ± 1 min) was significantly more (P-value = 0.000) than in the landmark-guided group (0.84 ± 0.72 min). The mean total procedure time for the USG group (5.98 ± 10.23 min) was more than that for the LMG group (4.86 ± 8.03 min) (P-value 0.542). Deviation of puncture site from the midline was seen in two patients in group A as compared to none in the USG group (P-value = 0.153). The number of patients requiring more than one attempt for successful needle insertion was more (P-value = 0.148) in the LMG group (20%) as compared to USG group (8%). Incidence of complications, like bleeding and desaturation was more in the LMG group as compared to the USG group. Conclusion: Ultrasound-guided PDT is associated with reduction in periprocedural complications as compared to landmark technique, although it takes slightly longer time.

Development of an institutional protocol for percutaneous dilatational tracheostomy in critically ill COVID-19 patients: Initial experience.

Background and Aims: Percutaneous dilatational tracheostomy (PDT) may improve the outcome in critically ill COVID-19 patients on mechanical ventilation. However, the timing of performing tracheostomy may be controversial, and it is an aerosol-generating procedure with a potential risk of viral exposure to healthcare workers. Material and Methods: An operational protocol for performing PDT was made and subsequently followed in a designated COVID-19 ICU. Critically ill adult patients on mechanical ventilators who underwent PDT were included in this retrospective cohort study. Case files were retrospectively reviewed and patient characteristics, clinical outcome, and procedure-related details were noted. Results: Forty-one patients were included in the analysis. The median age was 49 (39-67) years, and 41.5% of patients were females. The median duration of mechanical ventilation before tracheostomy was 10 (8-16) days, and the median (IQR) PaO2/FiO2 ratio on the day of PDT was 155 (125-180) mm Hg. Further, 48.8% of patients had transient desaturation to SpO2 <90%, and 41.5% survived to ICU discharge. None of the health care providers involved in PDT developed any symptoms of COVID 19. Conclusion: This descriptive study demonstrates the feasibility, implementation, and apparent safety of the PDT protocol developed at our institution.

Percutaneous dilatational tracheostomy: evaluation of YouTube videos.

BACKGROUND AND OBJECTIVE: In today's rapidly changing world, the technology of social media is widely used for educational purposes. Our aim in this study was to investigate the accuracy and efficacy of video presentations of percutaneous dilatational tracheostomy procedures available on the international video sharing website YouTube. METHODS: On 1 December 2020, the terms "percutaneous dilatational tracheostomy" and "percutaneous tracheostomy" were entered into the search feature of YouTube ( www.youtube.com ). The evaluation was made in three categories; general information about percutaneous tracheostomy, performing percutaneous tracheostomy steps and demographic features of videos. RESULTS: The median number of viewings of the videos on the date our data were collected was 1342 (IQR, 237-8052), and the most watched video had been viewed 325,170 times. Surgical site cleaning was explained in 46 (65.7%) videos and incision site detection in 55 (78.6%) videos. Needle aspiration into the trachea, insertion of the Seldinger guidewire, dilatation, and tracheal tube placement were covered in all videos (70; 100%). Confirmation of the location of the tracheal tube with end tidal capnography, the last step of the procedure, is available in 34 videos (48.6%). CONCLUSION: The use of inexpensive or freely available teaching materials is possible but should always be checked before use with respect to the completeness and correctness of the content conveyed. The unreflected adoption of such content can lead to serious treatment errors.

Modified Technique of Percutaneous Tracheostomy Using Borescope Camera: A Case Series.

Percutaneous dilatational tracheostomy (PDT) is a routinely performed procedure in the intensive care unit (ICU). Bronchoscopy guidance is recommended which requires expertise to use it, and also it is not readily available in all ICUs. Moreover, it can lead to carbondioxide (CO2) retention and hypoxia during the procedure. To overcome these issues, we are using a waterproof 4 mm borescope examination camera in place of a bronchoscope which allows continuous ventilation, and real-time images of the tracheal lumen can be viewed on a smartphone or a tablet during the procedure. These real-time images can be transmitted wirelessly to a control room where experts can monitor and guide the junior staff performing the procedure. We are reporting successful use of the borescope camera during PDT. How to cite this article: Mustahsin M, Srivastava A, Manchanda J, Kaushik R. Modified Technique of Percutaneous Tracheostomy Using Borescope Camera: A Case Series. Indian J Crit Care Med 2022;26(7):881-883.

Fiber-optic Bronchoscope-guided vs Mini-surgical Technique of Percutaneous Dilatational Tracheostomy in Intensive Care Units.

BACKGROUND: Percutaneous dilatational tracheostomy (PCDT) using fiber-optic bronchoscope (FOB) is a widely practiced technique, but its availability and cost remain a concern in nations with limited resources. Mini-surgical technique of PCDT incorporating minimal blunt dissection has shown improved results even without the use of FOB. The study is primarily intended to compare these two techniques and establish a safer cost-effective alternative to FOB-guided PCDTs. PATIENTS AND METHODS: This randomized comparative study [registered (CTRI/2018/04/013191)] was conducted on 120 mechanically ventilated patients. In 60 patients, mini-surgical PCDT (group-M) was performed with 2 cm longitudinal skin incision and blunt dissection till pretracheal fascia without FOB guidance using Portex-Ultraperc™ sets. In remaining 60 patients, PCDT was performed under FOB vision with similar skin incision (without blunt dissection) using Portex-Ultraperc™ sets (group-F). Two techniques were compared with regard to procedural time and percentage of complications occurred during or after the procedure. RESULTS: Procedure time [group-M: 6.30 ± 1.28 minutes; group-F: 14.43 ± 1.84 minutes (p <0.001)] and mean blood loss [group-M: 5.33 ± 1.69 mL; group-F: 6.87 ± 3.11 mL (p = 0.001)] was significantly less in group-M. Higher incidence of desaturation [group-M: 16.7%; group-F: 35% (p = 0.022)] was noted in group-F, whereas arrhythmias [group-M: 21.7%; group-F: 6.7% (p = 0.018)] were higher in group-M. There was no statistical difference in incidence of pneumothorax and subcutaneous emphysema. There was no incidence of posterior tracheal wall perforation in any of the patients. CONCLUSION: Mini-surgical technique is a faster alternative of FOB-guided PCDT with comparable incidence of complications. It can safely be used in intensive care units (ICUs) where FOB is not available. CLINICAL TRIAL REGISTRATION NUMBER: CTRI/2018/05/014307. NAME OF REGISTRY: Clinical Trials Registry of India (CTRI), URL-http://ctri.nic.in. HOW TO CITE THIS ARTICLE: Kumar A, Kohli A, Kachru N, Bhadoria P, Wadhawan S, Kumar D. Fiber-optic Bronchoscope-guided vs Mini-surgical Technique of Percutaneous Dilatational Tracheostomy in Intensive Care Units. Indian J Crit Care Med 2021;25(11):1269-1274.

Application of Endotracheal Tube Cuff Pressure Monitoring during Percutaneous Dilatational Tracheostomy: A Novel Technique.

Endotracheal tube (ETT) cuff pressure monitoring during percutaneous dilatational tracheostomy (PDT) procedure is an easy-to-use innovative addition to the standard blind technique in a resource-limited setting. This technique can be carried out without disconnecting the breathing circuit, resulting in a lower risk of infectious aerosol generation. HOW TO CITE THIS ARTICLE: Mohammad H, Jain G, Agarwal A, Kausar S, Sama S. Application of Endotracheal Tube Cuff Pressure Monitoring during Percutaneous Dilatational Tracheostomy: A Novel Technique. Indian J Crit Care Med 2021;25(9):1040-1041.