title: Retrosternal percutaneous tracheostomy: an approach for predictably impossible classic tracheostomy.
abstract: Percutaneous tracheostomy is a routine procedure in intensive care units. In cases of very low position of the larynx, cervical spine deformation, morbid obesity, or neck tumor, performance of the classic tracheostomy is inapplicable. Retrosternal approach to tracheostomy in such 20 patients is herein reported. After preoperative neck computerized tomography to define the neck anatomy, a small suprasternal incision followed by a short retrosternal tissue dissection to expose the trachea was done; the trachea was then catheterized at the level of the 2nd ring in the usual tracheostomy manner. The immediate and late (≥6 months) outcomes were similar to that of the standard tracheostomy. Thus, percutaneous retrosternal tracheostomy is safe in patients with abnormal positioning of the trachea or neck constitution. It is a bedside applicable technique, that, however, requires caution to avoid hazardous vascular complications.
authors.affiliation: Department of Cardiothoracic Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel.
authors.forename: Philippe
authors.initials: P
authors.lastname: Biderman
authors.forename: Avi A
authors.initials: AA
authors.lastname: Weinbroum
authors.forename: Yael
authors.initials: Y
authors.lastname: Rafaeli
authors.forename: Eyal
authors.initials: E
authors.lastname: Raz
authors.forename: Eyal
authors.initials: E
authors.lastname: Porat
authors.forename: Ory
authors.initials: O
authors.lastname: Wiesel
authors.forename: Oded
authors.initials: O
authors.lastname: Szold