Percutaneous dilatational tracheostomy with a double-lumen endotracheal tube: a comparison of feasibility, gas exchange, and airway pressures.
OBJECTIVE
Gas exchange and airway pressures are markedly altered during percutaneous dilatational tracheostomy (PDT). A double-lumen endotracheal tube (DLET) has been developed for better airway management during PDT. The current study prospectively evaluated the in vivo feasibility, gas exchange, and airway pressures during PDT with DLET compared with a conventional endotracheal tube (ETT).


METHODS
According to eligibility criteria, patients were divided into a case group (those receiving PDT with DLET) and a control group (those receiving PDT with a conventional ETT). The Ciaglia single-dilator technique was used for PDT in both groups. The primary end point of this study was the feasibility of tracheostomy with DLET. The secondary end points were a comparison of gas exchange, airway pressures, minute volume, and tidal volume before, during, and after PDT performed with DLET and conventional ETT.


RESULTS
Ten patients meeting the inclusion criteria were assigned to each group. PDTs were performed without difficulties in nine patients in the DLET group and 10 patients in the conventional ETT group. During PDT, gas exchange, airway pressures, and minute ventilation remained more stable in the DLET group and were significantly different from those in the conventional ETT group.


CONCLUSIONS
PDT with DLET can be performed safely without difficulties limiting the technique. Furthermore, during PDT, the use of the DLET resulted in more stable gas exchange, airway pressures, and ventilation than PDT with a conventional ETT.


BACKGROUND
ClinicalTrials.gov; No.: NCT01691222; URL: www.clinicaltrials.gov.
Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino IST, University of Genoa, Genoa, Department of Neurosciences, Reproductive and Odonthostomatological Sciences, University of Naples "Federico II," Naples, Italy.
Maria
M
Vargas
Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino IST, University of Genoa, Genoa, Italy.
Paolo
P
Pelosi
Department of Neurosciences, Reproductive and Odonthostomatological Sciences, University of Naples "Federico II," Naples, Italy.
Gaetano
G
Tessitore
Anesthesia and Intensive Care Unit, IRCCS Neuromed, Pozzilli (IS), Italy.
Fulvio
F
Aloj
Intensive Care Unit, IRCCS AOC San Martino IST, Genoa, Italy.
Iole
I
Brunetti
Intensive Care Unit, IRCCS AOC San Martino IST, Genoa, Italy.
Enrico
E
Arditi
Intensive Care Unit, IRCCS AOC San Martino IST, Genoa, Italy.
Dorino
D
Salami
Department of Anesthesiology and Critical Care and Department of Respiratory Care, Massachusetts General Hospital, Boston, MA.
Robert M
RM
Kacmarek
Department of Neurosciences, Reproductive and Odonthostomatological Sciences, University of Naples "Federico II," Naples, Anesthesia and Intensive Care Unit, IRCCS Neuromed, Pozzilli (IS), Italy. Electronic address: servillo@unina.it.
Giuseppe
G
Servillo
D000368:Aged; D000403:Airway Resistance; D016022:Case-Control Studies; D004106:Dilatation; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D014139:Tracheostomy / Q000379:methods*