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Clinical Investigations in Critical Care |

Assessment of Ventilation During the Performance of Elective Endoscopic-Guided Percutaneous Tracheostomy*: Clinical Evaluation of a New Method

Fausto Ferraro, MD; Antonella Capasso, MD; Emanuela Troise, MD; Stellina Lanza, MD; Gaetano Azan, MD; Fabio Rispoli, MD; Clara Belluomo Anello, MD
Author and Funding Information

*From the Dipartimento di Scienze Anestesiologiche, Chirurgiche e dell’Emergenza, Servizio di Terapia Intensiva, Seconda Università degli Studi di Napoli, Napoli, Italy.

Correspondence to: Fausto Ferraro, MD, Corso Vittorio Emanuele, 649/c, 80121, Napoli, Italy; e-mail: fausto.ferraro@unina2.it



Chest. 2004;126(1):159-164. doi:10.1378/chest.126.1.159
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Study objectives: To evaluate the feasibility of uninterrupted translaryngeal open ventilation delivered through a pediatric, uncuffed endotracheal tube during percutaneous endoscopic tracheostomy (PET).

Design and setting: Prospective, observational clinical study in a six-bed ICU of a university hospital.

Patients: Forty consecutive adult patients requiring an elective tracheostomy.

Interventions: We employed the basic Ciaglia technique with multiple dilators (n = 10), a single dilator (n = 15), and the Fantoni method (n = 15). During PET, pressure-controlled ventilation was maintained through an uncuffed, 4-mm inner-diameter pediatric tube. The fraction of inspired oxygen was 1.0. Ventilator settings were as follows: pressure-controlled ventilation, 40 cm H2O; respiratory rate, 25/min; inspiratory time, 1.2 s of inspiratory time (inspiratory/expiratory ratio, 1:1); and positive end-expiratory pressure, 0 cm H2O.

Measurements and results: Measurements of arterial blood gas (ABG) tensions were obtained before the start of each tracheostomy and every 3 min during the procedure. An average of 8.28 ± 2.28 ABG measurements were obtained from each patient (± SD). All patients were successfully assisted during performance of the tracheostomy, and no patient required ventilation through a cuffed endotracheal tube. The maximum increase in Paco2 was 8.49 ± 5.50 mm Hg, and the maximum decrease in pH related to hypercarbia was 0.04 ± 0.04. The Pao2 increased in all patients (maximum change, 69.75 ± 57.00 mm Hg; p < 0.01), and no patient had desaturation during the procedure.

Conclusions: The technique that we propose for airway management during PET was safe and effective. A mild increase in Paco2 was not associated with significant metabolic and hemodynamic consequences, and an adequate Pao2 was maintained throughout the study.

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