To determine if a method of balloon-facilitated percutaneous dilational tracheostomy previously described in pigs would be feasible in humans.
Three fresh human cadavers were utilized for the study. After evaluation of the palpable anatomy of the neck a 2 cm longitudinal incision was made followed by an 18G needle puncture of the trachea and passage of a stiff guidewire. Blunt dissection of subcutaneous tissues was not performed. After removal of the needle, a 14 fr. punch dilator was used to create a small tracheostoma. A lubricated 18mm x 45mm long balloon dilation catheter (Cook Inc., IN) combined with an 8.0 Shiley tracheostomy tube (Nellcor, Pleasanton CA) was placed 2.5 cm into the tracheostoma and inflated with normal saline to approximately 5 atmospheres for 3-5 seconds to dilate the subcutaneous and tracheal tissues. The balloon tracheostomy tube combination was then passed over the guidewire into the trachea and the balloon immediately deflated. The balloon was then removed leaving only the tracheostomy tube in place. The time for balloon deflation and withdrawal ranged 15-20 seconds.
A total of 7 tracheostomy procedures were completed. Two cadavers underwent 3 balloon-facilitated percutaneous tracheostomy tube placements each: one each at the cricothyroid membrane, between the 1st and 2nd tracheal rings, and between the 3rd and 4th tracheal rings. The 3rd cadaver underwent one percutaneous tracheostomy tube placement between the 1st and 2nd tracheal rings. Procedure times ranged 3-5 minutes from tracheal puncture to securing of the tube. Proper placement of the tracheostomy tube was confirmed by bronchoscopy. No damage was to the surrounding anatomic structures was evident. An incision size of 2 cm was considered imperative for successful placement.
This novel technique of balloon-facilitated percutaneous dilational tracheostomy appears to be feasible in humans.
Balloon-facilitated percutaneous dilational tracheostomy is a simple procedure that has the potential to decrease complications, procedue time and resources.
M. Zgoda, Cook Inc.