Pulmonary Procedures |

Is Neck Anatomy a Predictor of Successful Percutaneous Dilational Tracheostomy? FREE TO VIEW

Rebecca Cloyes, NP-C; Abdulgadir Adam, MD; David Chambers, MD; Shaheen Islam, MD
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Ohio State University, Columbus, OH

Chest. 2013;144(4_MeetingAbstracts):803A. doi:10.1378/chest.1705185
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SESSION TITLE: Bronchoscopy and Interventional Procedures Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Percutaneous Dilational Tracheostomy (PDT) is now routinely done in the intensive care units. Impalpable trachea or cricoid, short neck, and inability to extend the neck may make PDT difficult and often open surgical tracheostomy is preferred. We present our experience of PDT in difficult neck anatomy cases.

METHODS: A retrospective chart review was done between January 2010 and August 2012. PDT was performed only when the trachea, whether deep or superficial was palpable. Difficult Neck anatomy (DNA) was defined when any of the following were present; i) cricoid cartilage was not palpable, (ii) cricoid was palpable but the trachea was deep, (iii) the cricosternoid distance was less than 1.5cm (Short neck). All outcome variables were compared to those with normal neck anatomy (NNA).

RESULTS: Records of 104 PDTs were reviewed. 19 (20%) patients were identified as DNA. Eight (8%) had non-palpable cricoid cartilages, 12 (12%) had deep tracheal rings, 10 (10%) had short neck. More than two characteristics were present in 4 patients. There was no statistically significant difference in the type of tracheostomy tube placed (p=0.19). Average duration of intubation prior to PDT was 12.6 for the DNA compared to 11.9 for the NNA (p=0.035). Although there was an increased procedural bleeding in DNA, it was not statistically different compared to ANA (20% vs 10%, p=0.29).

CONCLUSIONS: PDT can be performed safely without an increased risk of complications with short neck, non-palpable cricoid or deep trachea when the trachea is palpable.

CLINICAL IMPLICATIONS: Difficult Neck Anatomy is not a contraindication for PDT

DISCLOSURE: The following authors have nothing to disclose: Rebecca Cloyes, Abdulgadir Adam, David Chambers, Shaheen Islam

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