SESSION TITLE: Critical Care
SESSION TYPE: Slide Presentations
PRESENTED ON: Monday, March 24, 2014 at 10:45 AM - 11:45 AM
PURPOSE: Cricothyrotomy is the emergency surgical means of gaining access to the airways. However it holds a lot of problems to the patient and is only a temporary measure until a definitive airway is reached. Griggs’ forceps technique for elective bedside percutaneous dilational tracheotomy (PDT) is safe, fast, and carries fewer complications in expert hands. This study aimed at comparing between emergency cricothyrotomy and emergency PDT in patients with failed intubation.
METHODS: Design: a comparative double blind randomized study. Emergency room of Alexandria main University Hospitals. Patients: 169 failed to intubate, and to ventilate patients. Methods: they were serially randomized into group I (85 patients): percutaneous cricothyrotomy and group II (85 patients): PDT using Griggs’ forceps technique. Group I: Percutaneous cricothyrotomy group: using the Seldinger 4-step cricothyrotomy technique with insertion of a suitable sized tube to connect to the ventilator circuit to begin ventilation. If failed, percutaneous dilational tracheotomy was performed as a definitive airway (cross group drop-out was not allowed after randomization). Group II: Percutaneous dilational tracheotomy group: using the Griggs’ forceps dilator technique with insertion of a suitable sized tube to connect to the ventilator circuit to begin ventilation. If failed, surgical tracheotomy was performed as a definitive airway (cross group drop-out was not allowed after randomization).
RESULTS: Total number of patients in need for intubation was 3785. Those with difficult airway were 365 patients (9.64%). Patients with difficult airway who sustained SpO2 ≥ 90% with BVM ventilation were 298 patients, 196 of them were successfully intubated soon and so were excluded from the study. Success rate was 95.3% in group I and 97.6% in group II (P=0.452). Procedure duration (in minutes) was 1.85±0.36 in group I versus 1.46±0.31 in group II (P=0.106). Lung atelectasis occurred to 8.2% of patients in group I only (P=0.011). Vocal cord injury occurred to 4.7% of patients in group I versus 1.2% in group II (P=0.074). Subglottic stenosis was recorded in 5.88% of patients in group I versus 1.2% in group II [P=0.039(P=0.452)].
CONCLUSIONS: Emergency PDT is feasible and safe in expert and trained hands in patients with failed emergency intubation.
CLINICAL IMPLICATIONS: Emeregency percutaneous tracheotomy in failed intubation is safe and could help in patients with acute respiratory failure.
DISCLOSURE: The following authors have nothing to disclose: Bassem Beshey, Hany Asaad, Emad Ibrahim
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