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Correspondence |

Assessment of Ventilation During the Performance of Elective Endoscopic-Guided Percutaneous TracheostomyVentilation During PDT: What’s New 10 Years Later?: What’s New 10 Years Later? FREE TO VIEW

Fausto Ferraro, MD; Pierluigi Fusco, MD; Daniela Di Martino, MD; Annarita Torino, MD
Author and Funding Information

From the Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples.

CORRESPONDENCE TO: Fausto Ferraro, MD, Department of Anesthesiological, Surgical and Emergency Services, Second University of Naples, Corso Vittorio Emanuele, 649/c-80121, Naples, Italy; e-mail: fausto.ferraro@unina2.it


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Editor’s Note: Authors are invited to respond to Correspondence that cites their previously published work. Those responses appear after the related letter. In cases where there is no response, the author of the original article declined to respond or did not reply to our invitation.

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Chest. 2015;148(1):e26-e27. doi:10.1378/chest.15-0191
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To the Editor:

We read with interest the carefully designed study by Vargas et al1 in a recent issue of CHEST (May 2015). The authors suggested that their technique is useful for any percutaneous dilatational tracheostomy procedure, but according to our experience, we claim that the proposed technique cannot be performed with retrograde procedures like the Fantoni translaryngeal tracheostomy.2 This is an important limitation that we overcame with our technique published 10 years ago.3

Another issue is the comparison between the double-lumen endotracheal tube (DLET) and the conventional endotracheal tube (ETT). According to the literature and field experience, ETT can induce potential life-threatening complications.4 Nevertheless, the results provided in the article indicated no complications in the ETT group and that 10% of patients treated with DLET had some sort of difficulty. These findings increase our doubts regarding the study by Vargas et al1 and represent the main reason why we do not agree with the achievement of the primary end point. We believe that the number of patients recruited for the study is not enough to make statistically sound conclusions. Despite these limitations, we agree with the results concerning the secondary end point. Furthermore, the use of DLET is impracticable in patients with infantile glottis; the DLET could damage the glottis during the exchange of the placed ETT using the airway exchange catheter, as done by the authors.

The endoscopic vision of the anatomic structures after DLET placement would be limited to the trachea because the fiber-optic bronchoscopy channel of the DLET does not allow any endoscopic tip flexure; in this way, possible lesions, anomalies, and decubiti could be missed. In addition, we believe that the procedure reduces or prevents the endoscopic vision of the surgical field because of the lack of air in the closed chamber created in the trachea. We believe that the reduced endoscopic vision increases the risk of complications. Our technique3,5 allows for wide endoscopic vision during the entire procedure without interfering with the ventilation and surgical equipment (Fig 1) and might be safer than the one suggested by Vargas et al.1 Finally, contrary to our continuous ventilation technique, cannula insertion occurred with the withdrawn DLET without any endoscopic vision, thus exposing patients to the same complications of a withdrawn ETT. For these reasons, we strongly believe that the use of the DLET should not be encouraged.

Figure Jump LinkFigure 1 –  Ciaglia blue rhino procedure (video bronchoscopic assisted) with small uncuffed endotracheal tube (ETT) positioned. A, Intercartilaginous placement of the introducer needle with ETT in the top. B, Dilative phase by Ciaglia blue rhino single dilator positioned over the guidewire: ring cartilage flexion in the tracheal lumen and ETT in the right side. C, Tracheostomy tube placement in the left side and the ETT in the right side. D, Bronchoscopic check through the tracheostomy tube to confirm its correct placement; the ETT is still in place in the right side before inflating the tracheostomy tube cuff.Grahic Jump Location

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. [CrossRef] [PubMed]
 
Fantoni A, Ripamonti D. A non-derivative, non-surgical tracheostomy: the translaryngeal method. Intensive Care Med. 1997;23(4):386-392. [CrossRef] [PubMed]
 
Ferraro F, Capasso A, Troise E, et al. Assessment of ventilation during the performance of elective endoscopic-guided percutaneous tracheostomy: clinical evaluation of a new method. Chest. 2004;126(1):159-164. [CrossRef] [PubMed]
 
Linstedt U, Möller F, Grote N, Zenz M, Prengel A. Intubating laryngeal mask as a ventilatory device during percutaneous dilatational tracheostomy: a descriptive study. Br J Anaesth. 2007;99(6):912-915. [CrossRef] [PubMed]
 
Ferraro F, Marfella R, Petruzzi J, Torino A, d’Elia A, Lettieri B. Translaryngeal open ventilation for percutaneous endoscopic tracheostomy. Br J Anaesth. 2014;113(1):189-190. [CrossRef] [PubMed]
 

Figures

Figure Jump LinkFigure 1 –  Ciaglia blue rhino procedure (video bronchoscopic assisted) with small uncuffed endotracheal tube (ETT) positioned. A, Intercartilaginous placement of the introducer needle with ETT in the top. B, Dilative phase by Ciaglia blue rhino single dilator positioned over the guidewire: ring cartilage flexion in the tracheal lumen and ETT in the right side. C, Tracheostomy tube placement in the left side and the ETT in the right side. D, Bronchoscopic check through the tracheostomy tube to confirm its correct placement; the ETT is still in place in the right side before inflating the tracheostomy tube cuff.Grahic Jump Location

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. [CrossRef] [PubMed]
 
Fantoni A, Ripamonti D. A non-derivative, non-surgical tracheostomy: the translaryngeal method. Intensive Care Med. 1997;23(4):386-392. [CrossRef] [PubMed]
 
Ferraro F, Capasso A, Troise E, et al. Assessment of ventilation during the performance of elective endoscopic-guided percutaneous tracheostomy: clinical evaluation of a new method. Chest. 2004;126(1):159-164. [CrossRef] [PubMed]
 
Linstedt U, Möller F, Grote N, Zenz M, Prengel A. Intubating laryngeal mask as a ventilatory device during percutaneous dilatational tracheostomy: a descriptive study. Br J Anaesth. 2007;99(6):912-915. [CrossRef] [PubMed]
 
Ferraro F, Marfella R, Petruzzi J, Torino A, d’Elia A, Lettieri B. Translaryngeal open ventilation for percutaneous endoscopic tracheostomy. Br J Anaesth. 2014;113(1):189-190. [CrossRef] [PubMed]
 
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