PURPOSE: Critical care physicians can perform tracheotomy using percutaneous dilational technique (PDT) with similar safety as in "open" surgical tracheotomy, although the complication profile differs. Current endotracheal tube (ETT) cuff withdrawal techniques during PDT utilize bronchoscopic guidance or are done "blindly" through tactile feedback of the cuff touching the vocal cords. Bronchoscopy adds time, complexity, equipment and skilled manpower while "blind" withdrawal can lead to unplanned extubation and cuff rupture. We report on the safety and efficacy of a GlideScope(r)Video Laryngoscope (GVL(r), Verathon Inc, Bothell, WA) assisted ETT cuff withdrawal technique.
METHODS: A retrospective review of data from consecutive PDT’s performed in our medical intensive care unit (MICU) from April, 2009 to April, 2010 were performed. All PDT’s were done using a GVL(r) assisted withdrawal technique, as follows; 1) a view of the glottis is obtained via GVL(r), 2) ETT is withdrawn until cuff is directly visualized at the level of the vocal cords, 3) ETT is held firmly in place prior to tracheal puncture with the guidewire introducer needle. Data on PDT complications were prospectively recorded with a standardized data collection instrument instituted for de-briefing purposes in our MICU. Occurrences of unplanned extubation, ETT cuff puncture, hypoxia, bleeding, and pneumomediastinum were recorded. Age, sex, diagnosis, and co-morbidities were obtained via retrospective chart review.
RESULTS: 53 patients underwent GVL(r)-assisted PDT during the study period. The median age was 68 years with 58% males. Average BMI was 25.2. 89% of patients underwent PDT without complication. There were no episodes of hypoxia, bleeding, or loss of airway access during any GVL(r)-assisted PDT. Five patients (9%) had needle puncture of the ETT tube cuff without clinical significance. One patient developed pneumomediastinum secondary to posterior tracheal injury sustained during dilation, with no intervention needed.
CONCLUSION: GVL(r)-assisted ETT withdrawal is a safe and effective method for performing PDT.
CLINICAL IMPLICATIONS: GVL(r)-assisted PDT is a simple and safe method that eliminates the need for bronchoscopic guidance.
DISCLOSURE: Joseph Mathew, No Financial Disclosure Information; No Product/Research Disclosure Information