PURPOSE: To demonstrate the utility of suspension laryngoscopy assisted percutaneous dilatational tracheostomy (SL-PDT) in the care of MICU and SICU patients with severe respiratory disease.
METHODS: Suspension laryngoscopy, an ENT endoscopy technique that traps the larynx was used in all patients to secure the airway. A rigid telescope was used for endotracheal recognizance. These two elements replace the portion of the standard PDT technique, which involves the partial extubation of the patient for the duration of the procedure and the endoscopy of the airway with a flexible bronchoscope. SL-PDT enables a complete seal of the airway ventilatory circuit such that pressure can be maintained even with high peak pressures and PEEP during the transition from dilation to intubation with the tracheotomy cannula. Retrospectively collected data from patients receiving bedside SL-PDT from March 2006 to October 2009 was reviewed. Patients with respiratory disease qualifying inclusion in this report included postural de-recruitment, PEEP greater than 8cm water, and FiO2 greater than 0.50.
RESULTS: Out of a series of 191 consecutive tracheotomy consults, all received SL-PDT and 22 patients met inclusion criteria having respiratory disease that might compromise the performance of the tracheotomy operation. Average age was 54 years, and median intubation length was 17 days (range 4-45d). Median PEEP was +12cm water (range 8-16), and median FiO2 was 70 (range 35-100). Four patients (18%) had transient desaturation (< 30 seconds) from de-recruitment during the procedure. One patient had a tracheal bleed during the procedure that was controlled with topical adrenaline alone. No vital sign instability or post operative complications were encountered.
CONCLUSION: SL-PDT offers a significant benefit to the ICU patient with high ventilatory needs that would normally exclude the patient for tracheotomy consideration even by open technique.
CLINICAL IMPLICATIONS: By expanding a bedside tracheotomy program to include SL-PDT, nearly all ICU patients, including those with prohibitively high ventilatory settings, can get a tracheotomy without the need and risks of transport to the OR.
DISCLOSURE: Nathan Alexander, No Financial Disclosure Information; No Product/Research Disclosure Information