In critical care medicine invasive procedures not only add substantial risk to patient care but can also change the course of patient recovery if done effectively and efficiently. Percutaneous tracheostomy (PCT) has become increasingly popular and has gained widespread acceptance.
We report a new technique that combines percutaneous tracheostomy with the use of direct video Laryngoscopy (GlideScope®) for proper positioning of endotreacheal tube (ETT). Standard technique consists of fiber optic scope that is passed through the ETT, then the ETT is retracted using the translumination method along with fiberoptic visualization of the trachea to ideally reposition the balloon below the vocal cords. We propose a new technique with the use of direct laryngoscopy. With the Glidescope in proper position we can directly visualize the ETT and the vocal cords. With the ETT balloon deflated the ETT is then retracted till the ETT balloon is seen just below the vocal cords. With the ETT balloon just distal to the vocal cords the balloon is then reinflated and the ETT is secured. After positioning of ETT is finalized you then can proceed with standard PCT.
We performed this technique on 20 patients in our medical intensive care unit and report no complications with this method. Adequate position was obtained in 18/20 patients with this method alone. In 2/20 the ETT was too low by transilumination, in these cases we pulled back the ETT 2 cm with good positioning. This new technique gives the operator a great sense of ETT stability. Overall, by using direct video laryngoscopy for repositioning of ETT prior to PCT no extra time was added to the procedure for 18/20 patients.
Direct video laryngoscopy can improve accuracy with little to no complications while positioning the endotracheal tube.
In the traditional technique you cannot visualize the vocal cords as you withdraw the ETT. Using the GlideScope® we can directly visualize the ETT positioning and place the balloon below the vocal cords with great accuracy.
Juan Pulido, No Financial Disclosure Information; No Product/Research Disclosure Information