Dawn B Sharp1, Paul F Castellanos. 1. Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294-0012, USA.
Abstract
OBJECTIVES: We sought to describe outcomes of a new technique blending suspension laryngoscopy (SL) with percutaneous dilatational tracheostomy (PDT), addressing concerns of airway control and risks of dire complications. METHODS: A retrospective review of 67 cases included "all comers", in that if the patient could undergo any type of tracheostomy, SL-PDT was offered, and it was performed in all but 1 patient. Patient demographics, intubation time, time from consultation to procedure, and perioperative complications were reviewed. RESULTS: Sixty-six patients underwent SL-PDT; 54 procedures were performed bedside in the intensive care unit, and 12 in the operating room. Use of the operating room was due to lack of intensivist availability or possible need for an emergent surgical airway. Early in the series, 1 patient required open tracheostomy because of unfavorable anatomy. Two major complications occurred: 1 perioperative airway obstruction and 1 severe bradycardic event. The 2 patients were resuscitated without significant sequelae. Three minor complications occurred: 2 cases of endotracheal bleeding and 1 transient bradycardic event. CONCLUSIONS: Bedside SL-PDT is relatively safe and effective, and offers advantages over traditional PDT and open tracheostomy. This novel technique may encourage a concerted multidisciplinary effort, including otolaryngologists, to continue to improve bedside airway management in critically ill patients.
OBJECTIVES: We sought to describe outcomes of a new technique blending suspension laryngoscopy (SL) with percutaneous dilatational tracheostomy (PDT), addressing concerns of airway control and risks of dire complications. METHODS: A retrospective review of 67 cases included "all comers", in that if the patient could undergo any type of tracheostomy, SL-PDT was offered, and it was performed in all but 1 patient. Patient demographics, intubation time, time from consultation to procedure, and perioperative complications were reviewed. RESULTS: Sixty-six patients underwent SL-PDT; 54 procedures were performed bedside in the intensive care unit, and 12 in the operating room. Use of the operating room was due to lack of intensivist availability or possible need for an emergent surgical airway. Early in the series, 1 patient required open tracheostomy because of unfavorable anatomy. Two major complications occurred: 1 perioperative airway obstruction and 1 severe bradycardic event. The 2 patients were resuscitated without significant sequelae. Three minor complications occurred: 2 cases of endotracheal bleeding and 1 transient bradycardic event. CONCLUSIONS: Bedside SL-PDT is relatively safe and effective, and offers advantages over traditional PDT and open tracheostomy. This novel technique may encourage a concerted multidisciplinary effort, including otolaryngologists, to continue to improve bedside airway management in critically illpatients.