A simplified technique for translaryngeal tracheostomy (TLT). A preliminary report.
OBJECTIVE
In this prospective observational study we present preliminary results of a modification of the translaryngeal tracheostomy technique that was introduced by Fantoni in 1997. The study was conducted in a five-bed surgical intensive care unit of a university teaching hospital.


METHODS
The study included 14 consecutive surgical patients (8 men, 6 women) who underwent a modified translaryngeal tracheostomy in a 6-month period. In our modification of the technique, we keep the basic principle of the inside-to-outside approach of the Fantoni technique, and combine it with a blind needle insertion, as reported in the classic subcricoid retrograde intubation technique. The technique that we use involves two medical doctors and a nurse.


RESULTS
Mean patient age was 68.9 years (range: 31-85 years) and mean APACHE II score was 15.8 (range: 6-31). Mean operative time for the procedure was 15.2 min (range: 11.5-22 min). Eight of the patients died during the postoperative course in the ICU from causes relevant to their surgical pathology. One patient survived to be discharged from the ICU but died of an acute myocardial infraction later in the same hospital stay. Five patients survived to be discharged from the hospital.


CONCLUSIONS
The modified translaryngeal tracheostomy seems to be as reliable and safe as the original technique. In addition, the modified technique is faster and can be performed without the use of an endoscope.
Katsaragakis
S
S
Surgical Intensive Care Unit, 1st Department of Propaedeutic Surgery, Athens University School of Medicine, Vas. Sofias 114 Ave., Hippocration Hospital, Athens, 11527, Greece.
Theodorou
D
D
Surgical Intensive Care Unit, 1st Department of Propaedeutic Surgery, Athens University School of Medicine, Vas. Sofias 114 Ave., Hippocration Hospital, Athens, 11527, Greece.
Drimousis
P
P
Surgical Intensive Care Unit, 1st Department of Propaedeutic Surgery, Athens University School of Medicine, Vas. Sofias 114 Ave., Hippocration Hospital, Athens, 11527, Greece. pdrimousis@hippocratio.gr.
Stamou
K M
KM
Surgical Intensive Care Unit, 1st Department of Propaedeutic Surgery, Athens University School of Medicine, Vas. Sofias 114 Ave., Hippocration Hospital, Athens, 11527, Greece.
Koutras
A
A
Surgical Intensive Care Unit, 1st Department of Propaedeutic Surgery, Athens University School of Medicine, Vas. Sofias 114 Ave., Hippocration Hospital, Athens, 11527, Greece.
Kapralou
A
A
Surgical Intensive Care Unit, 1st Department of Propaedeutic Surgery, Athens University School of Medicine, Vas. Sofias 114 Ave., Hippocration Hospital, Athens, 11527, Greece.
Bramis
J
J
Surgical Intensive Care Unit, 1st Department of Propaedeutic Surgery, Athens University School of Medicine, Vas. Sofias 114 Ave., Hippocration Hospital, Athens, 11527, Greece.
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D003422:Critical Care; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007828:Laryngoscopy; D007830:Larynx / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014139:Tracheostomy / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome