title: The 'Malawi device': a durable, reusable, low cost device from own materials for emergency ventilation during percutaneous tracheostomy.
abstract: The use of a tracheostomy is routine in current intensive care practice to facilitate weaning patients requiring prolonged respiratory support from mechanical ventilation. Percutaneous tracheostomy has become an established technique with an acceptable risk profile in appropriately selected patients, and has the advantage that it can be performed at the bedside without the need for an operating theatre. This is particularly relevant in a resource-poor setting. Ideally, percutaneous tracheostomy requires the presence of two skilled persons; one to perform the tracheostomy while the other controls the airway and withdraws the endo-tracheal tube at the appropriate time. This is not always possible in a resource poor setting with limited manpower. Without two operators, it is possible for the tracheal tube to become displaced before the completion of the tracheostomy with potentially disastrous consequences. We describe a method by which the airway and ventilation can be maintained if accidental tracheal extubation occurs before completion of a percutaneous tracheostomy. The 'Malawi Device', a cheap and simple modification of readily available equipment, enables a single operator to maintain the airway and ventilate the patient when the above scenario occurs.
authors.affiliation: Head of Department and Associate Professor, Department of Anaesthesia and Intensive Care, College of Medicine, University of Malawi, Malawi gpollach@medcol.mw.
authors.forename: Gregor
authors.initials: G
authors.lastname: Pollach
authors.affiliation: Deputy Head of Department and Consultant, Department of Anaesthesia and Intensive Care, University of Malawi, Malawi.
authors.forename: Felix
authors.initials: F
authors.lastname: Namboya
authors.affiliation: Lead Consultant in Intensive Care, Department of Anaesthesia and Intensive Care, University of Malawi, Malawi.
authors.forename: Kai
authors.initials: K
authors.lastname: Jung
mesh_terms: D000328:Adult; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000191:economics*; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation; D008297:Male; D019095:Point-of-Care Systems; D014139:Tracheostomy / Q000295:instrumentation* / Q000379:methods
keywords: Equipment; apparatus; device; emergency kit; emergency ventilation; percutaneous tracheostomy