Ella Even-Tov1,2,3, Itzhak Koifman4, Vladimir Rozentsvaig4, Leonid Livshits2,3, Peter Gilbey1,2,3. 1. Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel. 2. Otolaryngology, Head. 3. Neck Surgery Unit, Ziv Medical Center, Safed, Israel. 4. Intensive Care Unit, Ziv Medical Center, Safed, Israel.
Abstract
BACKGROUND: Percutaneous dilatational tracheostomy (PDT) has become a standard technique for critically ill patients who require long-term ventilation. The most common early post-operative complication is bleeding related to anatomical variation in vasculature. The procedure is performed at the patient's bedside unless this is deemed unsafe and then the accepted alternative is open tracheostomy in the operating room. OBJECTIVES: To evaluate the use of pre-procedural ultrasound to aid in the decision of whether PDT in critical care patients should be performed at the patient's bedside or by open surgical tracheostomy. METHODS: Patients were jointly evaluated by a critical care physician and a head and neck surgeon. Based on this evaluation, the method of tracheostomy was determined. Subsequently, pre-procedural ultrasound examination of the anterior neck was performed. The final decision whether to perform PDT or open surgical tracheostomy was based on the ultrasound findings. Changes in management decisions following ultrasound were recorded. RESULTS: We included 36 patients in this prospective study. Following ultrasound examination, the management decision was changed in nine patients (25%). CONCLUSIONS: Pre-procedural ultrasound for critically ill patients undergoing tracheostomy can influence management decisions regarding the performance of tracheostomy.
BACKGROUND: Percutaneous dilatational tracheostomy (PDT) has become a standard technique for critically illpatients who require long-term ventilation. The most common early post-operative complication is bleeding related to anatomical variation in vasculature. The procedure is performed at the patient's bedside unless this is deemed unsafe and then the accepted alternative is open tracheostomy in the operating room. OBJECTIVES: To evaluate the use of pre-procedural ultrasound to aid in the decision of whether PDT in critical care patients should be performed at the patient's bedside or by open surgical tracheostomy. METHODS:Patients were jointly evaluated by a critical care physician and a head and neck surgeon. Based on this evaluation, the method of tracheostomy was determined. Subsequently, pre-procedural ultrasound examination of the anterior neck was performed. The final decision whether to perform PDT or open surgical tracheostomy was based on the ultrasound findings. Changes in management decisions following ultrasound were recorded. RESULTS: We included 36 patients in this prospective study. Following ultrasound examination, the management decision was changed in nine patients (25%). CONCLUSIONS: Pre-procedural ultrasound for critically illpatients undergoing tracheostomy can influence management decisions regarding the performance of tracheostomy.
Authors: Onat Bermede; Mehmet Cahit Sarıcaoğlu; Volkan Baytaş; Ali İhsan Hasde; Mustafa Bahadır İnan; Ahmet Rüçhan Akar Journal: Turk Gogus Kalp Damar Cerrahisi Derg Date: 2021-10-20 Impact factor: 0.332