Suspension laryngoscopy-assisted percutaneous dilatational tracheostomy in high-risk patients.
OBJECTIVE
To describe the outcomes of bedside percutaneous dilatational tracheostomy (PDT) extended to the care of high-risk patients in the intensive care unit (ICU) by the use of suspension laryngoscopy (SL) to secure the airway.


METHODS
Retrospective chart review.


METHODS
The records of 117 consecutive patients who underwent suspension laryngoscopy-assisted percutaneous dilatational tracheostomy (SL-PDT) between April 2006 and May 2009 at our institution were reviewed. Data gathered included patient demographics, anatomical conditions, ventilator settings, intraoperative findings, presence of coagulopathy or anti-coagulation, and outcomes.


RESULTS
One hundred seventeen patients underwent SL-PDT. Eighty (68%) were considered high risk by virtue of one or more of the following: morbid obesity, coagulopathy, prior neck surgery or head and neck trauma, laryngotracheal stenosis or tracheomalacia, a high-riding innominate artery, or high ventilator demands. Thirty-five patients (30%) had two or more of these risk factors. A total of 11 (13.7 %) complications occurred in the high-risk group. Two major and nine minor complications occurred during the study. There were no adverse sequelae.


CONCLUSIONS
SL-PDT is a safe and effective means of bedside airway management in critically ill patients. This new technique offers several advantages over traditional percutaneous dilatational tracheostomy (T-PDT) and can be safely employed by otolaryngologists, especially in high-risk patients. This is most useful when T-PDT is considered untenable or when transport to the operating room for a standard open tracheostomy is considered too cumbersome or potentially dangerous.
Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Hilliary N
HN
White
Dawn B
DB
Sharp
Paul F
PF
Castellanos
D002404:Catheterization / Q000379:methods*; D016638:Critical Illness; D004417:Dyspnea / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014139:Tracheostomy / Q000379:methods*; D016896:Treatment Outcome