Assessment of ventilation during the performance of elective endoscopic-guided percutaneous tracheostomy: clinical evaluation of a new method.
OBJECTIVE
To evaluate the feasibility of uninterrupted translaryngeal open ventilation delivered through a pediatric, uncuffed endotracheal tube during percutaneous endoscopic tracheostomy (PET).


METHODS
Prospective, observational clinical study in a six-bed ICU of a university hospital.


METHODS
Forty consecutive adult patients requiring an elective tracheostomy.


METHODS
We employed the basic Ciaglia technique with multiple dilators (n = 10), a single dilator (n = 15), and the Fantoni method (n = 15). During PET, pressure-controlled ventilation was maintained through an uncuffed, 4-mm inner-diameter pediatric tube. The fraction of inspired oxygen was 1.0. Ventilator settings were as follows: pressure-controlled ventilation, 40 cm H(2)O; respiratory rate, 25/min; inspiratory time, 1.2 s of inspiratory time (inspiratory/expiratory ratio, 1:1); and positive end-expiratory pressure, 0 cm H(2)O.


RESULTS
Measurements of arterial blood gas (ABG) tensions were obtained before the start of each tracheostomy and every 3 min during the procedure. An average of 8.28 +/- 2.28 ABG measurements were obtained from each patient (+/- SD). All patients were successfully assisted during performance of the tracheostomy, and no patient required ventilation through a cuffed endotracheal tube. The maximum increase in PaCO(2) was 8.49 +/- 5.50 mm Hg, and the maximum decrease in pH related to hypercarbia was 0.04 +/- 0.04. The PaO(2) increased in all patients (maximum change, 69.75 +/- 57.00 mm Hg; p < 0.01), and no patient had desaturation during the procedure.


CONCLUSIONS
The technique that we propose for airway management during PET was safe and effective. A mild increase in PaCO(2) was not associated with significant metabolic and hemodynamic consequences, and an adequate PaO(2) was maintained throughout the study.
Ferraro
Fausto
F
Dipartimento di Scienze Anestesiologiche, Chirurgiche e dell'Emergenza, Servizio di Terapia Intensiva, Seconda Università degli Studi di Napoli, , Naples, Italy. fausto.ferraro@unina2.it
Capasso
Antonella
A
Troise
Emanuela
E
Lanza
Stellina
S
Azan
Gaetano
G
Rispoli
Fabio
F
Anello
Clara Belluomo
CB
D000368:Aged; D001999:Bronchoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D014139:Tracheostomy / Q000379:methods*