Tracheostomy under jet-ventilation--an alternative approach to ventilating patients undergoing surgically created or percutaneous dilational tracheostomy.
In a prospective observational study we compared the results of 297 elective tracheostomies under jet-ventilation with regard to its complication rate and practicability. Of those, 156 patients underwent surgically created tracheostomy (SCT) and 141 patients percutaneous dilational tracheostomy (PDT). Initially, in 159 patients jet-ventilation was performed using a jet-cannula inserted intratracheally through the cricothyroid membrane. In the remaining 138 patients the jet-ventilator was connected to the endoscopic instrument channel (2.2 mm ID, 4.9 mm OD, 600 mm Length) and ventilation via the fiberoptic bronchoscope (FB-15x, Pentax Europe GmbH, Hamburg) was applied manually. With jet-ventilation, oxygenation was maintained throughout the procedure as long as the tracheal puncture was successful und jet-cannula fixed in place. The bronchoscope-guided gas stream, when compared to jet-cannula inserted intratracheally, offered more space for tracheostomy and safety for the patient. The permanent danger of mishappenings and dislocation involved with the jet-cannula could be avoided, since the bronchoscope was operating on under direct visualization. Under these circumstances, PDT is an acceptable approach to inserting a tracheostomy tube under jet-ventilation via bronchoscope, particularly for the management of difficult airway in critically ill patients.
Abdulla
Walied
W
Department of Anaesthesiology and Intensive Care Medicine, Klinikum Bernburg. Teaching Hospital, Martin Luther University Halle-Wittenberg, Germany. wailed.abdulla@t-online.de
Netter
Ute
U
Abdulla
Susanne
S
Isaak
Igor
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D001999:Bronchoscopy; D002404:Catheterization; D003413:Cricoid Cartilage / Q000601:surgery; D005260:Female; D006611:High-Frequency Jet Ventilation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014139:Tracheostomy / Q000379:methods*