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Original Research: Pulmonary Procedures |

Percutaneous Dilatational Tracheostomy With a Double-Lumen Endotracheal TubeDouble Lumen Endotracheal Tube for Tracheostomy: A Comparison of Feasibility, Gas Exchange, and Airway Pressures

Maria Vargas, MD; Paolo Pelosi, MD; Gaetano Tessitore, MD; Fulvio Aloj, MD; Iole Brunetti, MD; Enrico Arditi, MD; Dorino Salami, MD; Robert M. Kacmarek, PhD, RRT; Giuseppe Servillo, MD
Author and Funding Information

From the Department of Neurosciences (Drs Vargas, Tessitore, and Servillo), Reproductive and Odonthostomatological Sciences, University of Naples “Federico II,” Naples, Italy; Department of Surgical Sciences and Integrated Diagnostics (Drs Vargas and Pelosi), IRCCS AOU San Martino IST, University of Genoa, Genoa, Italy; Anesthesia and Intensive Care Unit (Drs Aloj and Servillo), IRCCS Neuromed, Pozzilli (IS), Italy; Intensive Care Unit (Drs Brunetti, Arditi, and Salami), IRCCS AOC San Martino IST, Genoa, Italy; and Department of Anesthesiology and Critical Care and Department of Respiratory Care (Dr Kacmarek), Massachusetts General Hospital, Boston, MA.

CORRESPONDENCE TO: Giuseppe Servillo, MD, Department of Neurosciences, Reproductive and Odonthostomatological Sciences, University of Naples “Federico II,” Corso Umberto I, 40, 80138 Naples, Italy; e-mail: servillo@unina.it


FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(5):1267-1274. doi:10.1378/chest.14-1465
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OBJECTIVE:  Gas exchange and airway pressures are markedly altered during percutaneous dilatational tracheostomy (PDT). A double-lumen endotracheal tube (DLET) has been developed for better airway management during PDT. The current study prospectively evaluated the in vivo feasibility, gas exchange, and airway pressures during PDT with DLET compared with a conventional endotracheal tube (ETT).

METHODS:  According to eligibility criteria, patients were divided into a case group (those receiving PDT with DLET) and a control group (those receiving PDT with a conventional ETT). The Ciaglia single-dilator technique was used for PDT in both groups. The primary end point of this study was the feasibility of tracheostomy with DLET. The secondary end points were a comparison of gas exchange, airway pressures, minute volume, and tidal volume before, during, and after PDT performed with DLET and conventional ETT.

RESULTS:  Ten patients meeting the inclusion criteria were assigned to each group. PDTs were performed without difficulties in nine patients in the DLET group and 10 patients in the conventional ETT group. During PDT, gas exchange, airway pressures, and minute ventilation remained more stable in the DLET group and were significantly different from those in the conventional ETT group.

CONCLUSIONS:  PDT with DLET can be performed safely without difficulties limiting the technique. Furthermore, during PDT, the use of the DLET resulted in more stable gas exchange, airway pressures, and ventilation than PDT with a conventional ETT.

TRIAL REGISTRY:  ClinicalTrials.gov; No.: NCT01691222; URL: www.clinicaltrials.gov

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