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Maria Vargas, MD; Paolo Pelosi, MD; Robert M. Kacmarek, PhD, RRT; Giuseppe Servillo, MD
Author and Funding Information

From the Department of Neurosciences, Reproductive and Odonthostomatological Sciences (Drs Vargas and Servillo), University of Naples “Federico II”; the Department of Surgical Sciences and Integrated Diagnostics (Drs Vargas and Pelosi), IRCCS AOU San Martino IST, University of Genoa; and the Department of Anesthesiology and Critical Care and Department of Respiratory Care (Dr Kacmarek), Massachusetts General Hospital.

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


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following conflicts: Dr Kacmarek is a consultant for Covidien and has received an honorarium for a single lecture at the American Association for Respiratory Care annual meeting from MAQUET Holding BV & Co KG. Dr Servillo holds a national patent (No. RM2011A000258) and an international patent (No. PCT/IT2012/000154–Orotracheal tube for Tracheostomy Procedure). Both patents have been licensed to DEAS SRL (Italy). Drs Vargas and Pelosi have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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):e193. doi:10.1378/chest.15-0185
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To the Editor:

We read with interest the comments by Dr Sangwan regarding our article in this issue of CHEST.1 Sangwan et al2 described a new endotracheal tube designed to enable a single operator to perform percutaneous tracheostomy (PT) while keeping the airway and maintaining continuous bronchoscopic guidance aimed at minimizing procedural complications. This device was tested on a mannequin and a cadaver but not in patients.2 Our double-lumen endotracheal tube (DLET) for PT has an international patent application No. PCT/IT/2012/000154.

DLET has some characteristics different from the easy tracheostomy (EZT) described by Sangwan et al.2 The upper lumen of DLET for bronchoscopic viewing has an internal diameter of 9 mm, whereas the EZT is only 3.5 mm. As a consequence, the EZT accommodates only a pediatric bronchoscope. Furthermore, our DLET does not have a proximal cuff; the length between the tip of the upper tube and the distal cuff is fixed.1 At the beginning of PT, the DLET can be placed with a tube exchanger to maintain a stable airway throughout the procedure. We agree with Dr Sangwan that a skilled operator is needed to manage an accidental extubation during PT, since reintubation during PT may be very difficult because of the necessary upper airway and tracheal manipulation. The use of a bronchoscope during PT results not only in an impairment of gas exchange but also in an increase of airway pressure due to air trapping and lung overinflation.1,3 Indeed, the safest ventilatory settings during PT are unknown, and research on this topic is urgently needed.3 The DLET during PT maintains stable gas exchange and avoids increases of airway pressure and development of intrinsic positive end-expiratory pressure.1

The aim of DLET is to increase the safety profile of PT. PT techniques are associated with increased technical difficulties when comparing with surgical tracheostomy. Furthermore, different PT techniques are associated with intraprocedural risks; however, multiple- and single-step dilatational tracheostomies have the lowest odds ratio.4

The DLET introduces additional safety to PT, allowing continuous bronchoscopic viewing, stable ventilation and airway management, and protection of lung and posterior tracheal wall.1,5 During PT, if complications occur, the DLET may provide better patient protection.

References

Vargas M, Pelosi P, Tessitore G, et al. Percutaneous dilatational tracheostomy with a double-lumen endotracheal tube: a comparison of feasibility, gas exchange, and airway pressures. Chest. 2015;147(5):1267-1274.
 
Sangwan YS, Koveleskie J, Palomino J, Simeone F. A new endotracheal tube designed to enable a single operator to perform percutaneous dilatational tracheostomy while maintaining the airway, providing continuous bronchoscopic guidance, and minimizing procedural complications: demonstration of feasibility on a mannequin and a cadaver. J Bronchology Interv Pulmonol. 2011;18(4):368-373. [CrossRef] [PubMed]
 
Cabrini L, Greco M, Pasin L, Monti G, Colombo S, Zangrillo A. Preventing deaths related to percutaneous tracheostomy: safety is never too much! Crit Care. 2014;18(1):406. [CrossRef] [PubMed]
 
Putensen C, Theuerkauf N, Guenther U, Vargas M, Pelosi P. Percutaneous and surgical tracheostomy in critically ill adult patients: a meta-analysis. Crit Care. 2014;18(6):544. [CrossRef] [PubMed]
 
Vargas M, Servillo G, Tessitore G, et al. Double lumen endotracheal tube for percutaneous tracheostomy. Respir Care. 2014;59(11):1652-1659. [CrossRef] [PubMed]
 

Figures

Tables

References

Vargas M, Pelosi P, Tessitore G, et al. Percutaneous dilatational tracheostomy with a double-lumen endotracheal tube: a comparison of feasibility, gas exchange, and airway pressures. Chest. 2015;147(5):1267-1274.
 
Sangwan YS, Koveleskie J, Palomino J, Simeone F. A new endotracheal tube designed to enable a single operator to perform percutaneous dilatational tracheostomy while maintaining the airway, providing continuous bronchoscopic guidance, and minimizing procedural complications: demonstration of feasibility on a mannequin and a cadaver. J Bronchology Interv Pulmonol. 2011;18(4):368-373. [CrossRef] [PubMed]
 
Cabrini L, Greco M, Pasin L, Monti G, Colombo S, Zangrillo A. Preventing deaths related to percutaneous tracheostomy: safety is never too much! Crit Care. 2014;18(1):406. [CrossRef] [PubMed]
 
Putensen C, Theuerkauf N, Guenther U, Vargas M, Pelosi P. Percutaneous and surgical tracheostomy in critically ill adult patients: a meta-analysis. Crit Care. 2014;18(6):544. [CrossRef] [PubMed]
 
Vargas M, Servillo G, Tessitore G, et al. Double lumen endotracheal tube for percutaneous tracheostomy. Respir Care. 2014;59(11):1652-1659. [CrossRef] [PubMed]
 
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