Translaryngeal tracheostomy: two modified techniques versus the basic technique--early experience in 75 critically ill adults.
OBJECTIVE
Elective tracheostomy is an established procedure in the management of ICU patients on long-term ventilation. In addition, percutaneous tracheostomy techniques are increasingly being used. In 1997, Fantoni's translaryngeal technique (TLT), another minimally invasive procedure, was introduced. While clinical studies of TLT showed that the technique is safe and can be performed rapidly, technical difficulties which sometimes led to prolonged operating times were also noted. Our study compared the basic TLT technique to a modified TLT approach and to TLT performed with the manufacturer's new, improved "Straight Cannula" set. Twenty-five patients were enrolled in each group, and the advantages and disadvantages of the respective techniques were evaluated.


METHODS
Surgical ICU of a university hospital.


METHODS
Seventy-five adult, surgical intensive care patients.


RESULTS
Average operating times with the modified TLT techniques were significantly shorter, 4 and 5 min respectively, as compared to 11 min for the basic TLT technique. Initially, use of the new, improved TLT set resulted in a complete passage of the tracheal cannula in two patients; uneventful Griggs's tracheostomy was performed instead. Regardless of the technique used, no other perioperative complications were noted and the perioperative gas exchange remained unaffected by the tracheostomy procedure.


CONCLUSIONS
The modified TLT procedures are safer and more readily performed than the basic technique. Difficulty in the retrograde passage of the guide wire was seen only occasionally with the modified techniques. Based on our data we conclude that the modified techniques are superior to the basic technique and represent significant progress in TLT.
Byhahn
C
C
Department of Anesthesiology, Intensive Care Medicine and Pain Control, J.W. Goethe University Hospital Center, Frankfurt, Germany. c.byhahn@em.uni-frankfurt.de
Wilke
H J
HJ
Lischke
V
V
Westphal
K
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D018709:Statistics, Nonparametric; D014139:Tracheostomy / Q000379:methods*; D016896:Treatment Outcome