Published November 26, 2022 | Version v1
Journal article Open

Fiberoptic bronchoscopic guided versus ultrasound guided percutaneous tracheotomy in critically ill patients

Authors/Creators

  • 1. Professor of Critical Care medicine, Faculty of medicine, Alexandria University, Alexandria, Egypt
  • 2. Assistant professor of Critical Care medicine, Alexandria University, Alexandria, Egypt
  • 3. Assistant lecturer of Critical Care medicine, Alexandria University, Alexandria, Egypt

Description

ABSTRACT

A lot of assisting tools have been used as guidance during percutaneous dilational tracheotomy PDT, we compared fiberoptic bronchoscopic guided versus ultrasound US guided PDT and using both techniques together as regards ease of the technique and complications of the procedure. Design: A randomized prospective study. Setting: Critical care department, main Alexandria university hospital. 75 critically ill patients, requiring elective PDT. Patients were assigned to 3 groups; fiberoptic bronchoscopic PDT (Group I), US guided PDT (Group II) and using both techniques (Group III). All groups used the Ciaglia technique for PDT. Duration of the procedures and perioperative complications were recorded. In group I, total time was 6.15 ± 1.48 minutes while in group II was 6.99 ±1.55 minutes and it was 13.78 ± 2.34 minutes in group III.  Hypoxia was found in 4 patients in group I versus 1 and 3 patients in group II and III respectively. Bleeding occurred in 3 patients in group I, 1 patient in group II and 2 patients in group III. US and bronchoscopic-guided PDT are associated with similar complication rate and clinical outcome but using both techniques together may increase the duration of the procedure without additive value.

Keywords: Percutaneous tracheotomy, PDT, Hypoxia, bronchoscopic, Ciaglia technique

REFERENCES

  1. Freeman BD, Morris PE. Tracheostomy practice in adults with acute respiratory failure. Crit Care Med. 2012;40(10):2890-6.
  2. Dennis BM, Eckert MJ, Gunter OL, Morris JA, Jr., May AK. Safety of bedside percutaneous tracheostomy in the critically ill: evaluation of more than 3,000 procedures. Journal of the American College of Surgeons. 2013;216(4):858-65; discussion 65-7.
  3. Kost KM. Endoscopic percutaneous dilatational tracheotomy: a prospective evaluation of 500 consecutive cases. Laryngoscope. 2005;115(10 Pt 2):1-30.
  4. Ultrasound-guided percutaneous dilational tracheostomy versus bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients (TRACHUS): a randomized noninferiority controlled trial. Intensive Care Medicine. 2016;42(3):342-51.
  5. Hardee PS, Ng SY, Cashman M. Ultrasound imaging in the preoperative estimation of the size of tracheostomy tube required in specialised operations in children. The British journal of oral & maxillofacial surgery. 2003;41(5):312-6.
  6. Mitra S, Kapoor D, Srivastava M, Sandhu H. Real-time ultrasound guided percutaneous dilatational tracheostomy in critically ill patients: A step towards safety! Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine. 2013;17(6):367-9.
  7. Ambesh SP, Pandey CK, Srivastava S, Agarwal A, Singh DK. Percutaneous tracheostomy with single dilatation technique: a prospective, randomized comparison of Ciaglia blue rhino versus Griggs' guidewire dilating forceps. Anesth Analg. 2002;95(6):1739-45, table of contents.
  8. Fikkers BG, Staatsen M, Lardenoije SGGF, van den Hoogen FJA, van der Hoeven JG. Comparison of two percutaneous tracheostomy techniques, guide wire dilating forceps and Ciaglia Blue Rhino: a sequential cohort study. Critical Care. 2004;8(5):R299-R305.
  9. Romero CM, Cornejo RA, Ruiz MH, Galvez LR, Llanos OP, Tobar EA, et al. Fiberoptic bronchoscopy-assisted percutaneous tracheostomy is safe in obese critically ill patients: a prospective and comparative study. J Crit Care. 2009;24(4):494-500.
  10. McCormick B, Manara AR. Mortality from percutaneous dilatational tracheostomy. A report of three cases. Anaesthesia. 2005;60(5):490-5.
  11. van Heurn LW, Theunissen PH, Ramsay G, Brink PR. Pathologic changes of the trachea after percutaneous dilatational tracheotomy. Chest. 1996;109(6):1466-9.
  12. Walz MK, Schmidt U. Tracheal lesion caused by percutaneous dilatational tracheostomy--a clinico-pathological study. Intensive Care Med. 1999;25(1):102-5.
  13. Reilly PM, Anderson HL, 3rd, Sing RF, Schwab CW, Bartlett RH. Occult hypercarbia. An unrecognized phenomenon during percutaneous endoscopic tracheostomy. Chest. 1995;107(6):1760-3.
  14. Al-Ansari MA, Hijazi MH. Clinical review: percutaneous dilatational tracheostomy. Crit Care. 2006;10(1):202.
  15. Gobatto AL, Besen BA, Tierno PF, Mendes PV, Cadamuro F, Joelsons D, et al. Ultrasound-guided percutaneous dilational tracheostomy versus bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients (TRACHUS): a randomized noninferiority controlled trial. Intensive Care Med. 2016;42(3):342-51.
  16. Chacko J, Gagan B, Kumar U, Mundlapudi B. Real-time ultrasound guided percutaneous dilatational tracheostomy with and without bronchoscopic control: an observational study. Minerva anestesiologica. 2015;81(2):166-74.
  17. Gonzalez I, Bonner S. Routine chest radiographs after endoscopically guided percutaneous dilatational tracheostomy. Chest. 2004;125(3):1173-4.
  18. Sateesh Pujari, & Estari Mamidala. (2015). Anti-diabetic activity of Physagulin-F isolated from Physalis angulata fruits. The American Journal of Science and Medical Research, 1(2), 53–60. https://doi.org/10.5281/zenodo.7352308
  19. Anon JM, Gomez V, Escuela MP, De Paz V, Solana LF, De La Casa RM, et al. Percutaneous tracheostomy: comparison of Ciaglia and Griggs techniques. Crit Care. 2000;4(2):124-8.
  20. Sustic A, Krstulovic B, Eskinja N, Zelic M, Ledic D, Turina D. Surgical tracheostomy versus percutaneous dilational tracheostomy in patients with anterior cervical spine fixation: preliminary report. Spine. 2002;27(17):1942-5; discussion 5.
  21. Beshey B, Helmy T, Asaad H, Ibrahim E. Emeregency percutaneous tracheotomy in failed intubation. European Respiratory Journal. 2013;42(Suppl 57).
  22. Ravi PR, Vijay MN. Real time ultrasound-guided percutaneous tracheostomy: Is it a better option than bronchoscopic guided percutaneous tracheostomy? Medical Journal, Armed Forces India. 2015;71(2):158-64.
  23. Gobatto ALN, Besen BAMP, Tierno PFGMM, Mendes PV, Cadamuro F, Joelsons D, et al. Comparison between ultrasound- and bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients: A retrospective cohort study. Journal of Critical Care. 2015;30(1):220.e13-.e17.

Files

52.9n.pdf

Files (1.0 MB)

Name Size
md5:df22bcdd8e2f273a0f2d284bb16fe494
1.0 MB Preview Download