Acute and Critical Care

Original Articles

Pulmonary
The feasibility and safety of percutaneous dilatational tracheostomy without endotracheal guidance in the intensive care unit: Ji Eun Kim, Dong Hyun Lee; Acute Crit Care. 2022;37(1):101-107. Published online February 17, 2022; DOI: https://doi.org/10.4266/acc.2021.00906

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Abstract PDF: Background
Percutaneous dilatational tracheostomy (PDT) is a common procedure in intensive care units (ICUs). Although it is thought to be safe and easily performed at the bedside, PDT usually requires endotracheal guidance, such as bronchoscopy. Here, we assessed the clinical outcomes and safety of PDT conducted without endotracheal guidance.
Methods
In the ICU and coronary ICU at a tertiary hospital, PDT was routinely performed without endotracheal guidance by a single medical intensivist using the Griggs technique PDT kit (Portex Percutaneous Tracheostomy Kit). We retrospectively reviewed the electronic medical records of patients who underwent PDT without endotracheal guidance.
Results
From January 1 to December 31, 2018, 78 patients underwent PDT without endotracheal guidance in the ICU and coronary ICU. The mean age of these subjects was 71.9±11.5 years, and 29 (37.2%) were female. The mean Acute Physiology And Chronic Health Evaluation (APACHE) II score at 24 hours after admission was 25.9±5.8. Fifty patients (64.1%) were on mechanical ventilation during PDT. Failure of the initial PDT attempt occurred in 4 patients (5.1%). In two of them, PDT was aborted and converted to surgical tracheostomy; in the other two patients, PDT was reattempted after endotracheal reintubation, with success. Minor bleeding at the tracheostomy site requiring gauze changes was observed in five patients (6.4%). There were no airway problems requiring therapeutic interventions or procedure-related sequelae.
Conclusions
PDT without endotracheal guidance can be considered safe and feasible.

Pulmonary
Safety and feasibility of hybrid tracheostomy: Daeun Kang, In Beom Jeong, Sun Jung Kwon, Ji Woong Son, Gwan Woo Ku; Acute Crit Care. 2021;36(4):369-373. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00801

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Background
Percutaneous dilatational tracheostomy (PDT) is widely used in intensive care units, but this conventional method has some disadvantages, such as requirement of a lot of equipment and experts at the site. Especially, in situations where the patient is isolated due to an infectious disease, difficulties in using the equipment may occur, and the number of exposed persons may increase. In this paper, we introduce hybrid tracheostomy that combines the advantages of surgical tracheostomy and PDT and describe our experiences.
Methods
Data from 55 patients who received hybrid tracheostomy without bronchoscopy from January 2020 to February 2021 were collected and reviewed retrospectively. Hybrid tracheostomy was performed at the bedside by a single thoracic surgeon. The hybrid tracheostomy method was as follows: after the skin was incised and the trachea was exposed, only the extent of the endotracheal tube that could not be removed was withdrawn, and then tracheostomy was performed by the Seldinger method using a PDT kit.
Results
The average age was 66.5 years, and the proportion of men was 69.1%. Among the patients, 21.8% were taking antiplatelet drugs and 14.5% were taking anticoagulants. The average duration of the procedure was 13.3 minutes. There was no major bleeding, and there was one case of paratracheal placement of the tracheostomy tube.
Conclusions
In most patients, the procedure can be safely performed without any major complications. However, patients with a short neck, a neck burn or patients who have received radiation therapy to the neck should be treated with conventional methods.

Citations

Citations to this article as recorded by

A Modified Technique for Percutaneous Dilatational Tracheostomy
Zahra Ghotbi, Mehrdad Estakhr, Mehdi Nikandish, Reza Nikandish
Journal of Intensive Care Medicine.2023; 38(9): 878. CrossRef

Pulmonary
Experience of percutaneous tracheostomy in critically ill COVID-19 patients: Eun Jin Kim, Eun-Hyung Yoo, Chi Young Jung, Kyung Chan Kim; Acute Crit Care. 2020;35(4):263-270. Published online November 12, 2020; DOI: https://doi.org/10.4266/acc.2020.00444

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Abstract PDF

Background
Coronavirus disease 2019 (COVID-19) is a highly contagious disease that causes respiratory failure. Tracheostomy is an essential procedure in critically ill COVID-19 patients; however, it is an aerosol-generating technique and thus carries the risk of infection transmission. We report our experience with percutaneous tracheostomy and its safety in a real medical setting.
Methods
During the COVID-19 outbreak, 13 critically ill patients were admitted to the intensive care unit (ICU) at Daegu Catholic University Medical Center between February 24 and April 30, 2020. Seven of these patients underwent percutaneous tracheostomy using Ciaglia Blue Rhino. The medical environment, percutaneous tracheostomy method, and COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) results were retrospectively reviewed. After treatment, the COVID-19 infection status of healthcare personnel was investigated by RT-PCR.
Results
The ICU contained negative pressure cohort areas and isolation rooms, and healthcare personnel wore a powered air-purifying respirator system. We performed seven cases of percutaneous tracheostomy in the same way as in patients without COVID-19. Five patients (71.4%) tested positive for COVID-19 by RT-PCR at the time of tracheostomy. The median cycle threshold value for the RNA-dependent RNA polymerase was 30.60 (interquartile range [IQR], 25.50–36.56) in the upper respiratory tract and 35.04 (IQR, 28.40–36.74) in the lower respiratory tract. All healthcare personnel tested negative for COVID-19 by RT-PCR.
Conclusions
Percutaneous tracheostomy was performed with conventional methods in the negative pressure cohort area. It was safe to perform percutaneous tracheostomy in an environment of COVID-19 infection.

Citations

Citations to this article as recorded by

Sedation and Analgesia in Patients Undergoing Tracheostomy in COVID-19, a Multi-Center Registry
Christopher M. Kapp, Ardian Latifi, David Feller-Kopman, Joshua H. Atkins, Esther Ben Or, David Dibardino, Andrew R. Haas, Jeffrey Thiboutot, Christoph T. Hutchinson
Journal of Intensive Care Medicine.2022; 37(2): 240. CrossRef
Percutaneous Tracheostomy in Respiratory Failure Due to COVID-19
Samuel E. Cohen, Angelena R. Lopez, Philip K. Ng, Oren A. Friedman, George E. Chaux
Journal of Bronchology & Interventional Pulmonology.2022; 29(2): 125. CrossRef
Expert consensus on the diagnosis and treatment of severe and critical coronavirus disease 2019 (COVID-19)
You Shang, Jianfeng Wu, Jinglun Liu, Yun Long, Jianfeng Xie, Dong Zhang, Bo Hu, Yuan Zong, Xuelian Liao, Xiuling Shang, Renyu Ding, Kai Kang, Jiao Liu, Aijun Pan, Yonghao Xu, Changsong Wang, Qianghong Xu, Xijing Zhang, Jicheng Zhang, Ling Liu, Jiancheng Z
Journal of Intensive Medicine.2022; 2(4): 199. CrossRef
Commentary: Coronavirus disease 2019 (COVID-19) tracheostomies—The “how” but not the “why” or “when”
Benjamin Wei, Peter Abraham
JTCVS Techniques.2021; 6: 190. CrossRef
Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals
Phillip Staibano, Marc Levin, Tobial McHugh, Michael Gupta, Doron D. Sommer
JAMA Otolaryngology–Head & Neck Surgery.2021; 147(7): 646. CrossRef
Tracheostomy in COVID Times
Yatin Mehta, Gaurav Kochar
Journal of Cardiac Critical Care TSS.2021; 5(02): 082. CrossRef

Case Report

CPR/Resuscitation
Fatal airway obstruction due to a ball-valve clot with identical signs of tension pneumothorax: Hisaaki Munakata, Michiko Higashi, Takahiro Tamura, Yushi Ueda Adachi; Acute Crit Care. 2020;35(4):298-301. Published online April 20, 2020; DOI: https://doi.org/10.4266/acc.2019.00570

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Abstract PDF

Endo-tracheal tube obstruction due to an extensive blood clot is a recognized but very rare complication. A ball-valve obstruction in the airway could function as a check valve for the lung and thorax, resulting in tension pneumothorax-like abnormalities. A 47-year-old female patient had undergone implantation of a left ventricular assist device 3 weeks prior. On post-operative day 17, planned thoracentesis was performed for drainage of a pleural effusion. Despite the drainage, the patient’s oxygenation did not improve, and emergency tracheal intubation was conducted. Subsequent computed tomography revealed bilateral pneumothorax. Two days later, the patient’s trachea was extubated without complication, and a mini-tracheostomy tube was placed. Three hours later, reintubation was conducted due to progressive tachypnea. Although successful intubation was confirmed, ventilation became increasingly difficult and finally impossible. Marked increase in pulmonary artery and central venous pressures suggested progression of the previous tension pneumothorax. After emergency extracorporeal membrane oxygenation was initiated, fiberoptic bronchoscopy revealed the presence of a massive clot and ball-valve obstruction of the endotracheal tube. Two weeks later, the patient died due to severe hypoxic brain damage. Diagnosis of ball valve clot is not simple, but intensivists should consider this rare complication.

Citations

Citations to this article as recorded by

Extracorporeal membrane oxygenation in critical airway interventional therapy: A review
Hongxia Wu, Kaiquan Zhuo, Deyun Cheng
Frontiers in Oncology.2023;[Epub] CrossRef
Endobronchial hydatid cyst causing variable intrathoracic airflow limitation selectively during expiration acting as a ball valve
Pavan Kumar Dammalapati, Sandeep Kumar Kar, Chaitali Sen Dasgupta
Indian Journal of Thoracic and Cardiovascular Surgery.2023; 39(4): 438. CrossRef
In reply: Non-ventilated lung airway occlusion during one-lung ventilation: a need for further research?
Jacques Somma, Edouard Marques, Jean S. Bussières
Canadian Journal of Anesthesia/Journal canadien d'anesthésie.2021; 68(9): 1458. CrossRef
A case of haemoptysis and bilateral areas of lung consolidation sparing the right lower lobe
Nadia Corcione, Antonio Ponticiello, Severo Campione, Alfonso Pecoraro, Livio Moccia, Giuseppe Failla
Breathe.2021; 17(4): 210072. CrossRef

Original Articles

Nursing
The Effect of Systematic Approach to Tracheostomy Care in Patients Transferred from the Surgical Intensive Care Unit to General Ward: Yooun-joong Jung, Younghwan Kim, Kyuhyouck Kyoung, Minae Keum, Taehyun Kim, Dae seong Ma, Suk-Kyung Hong; Acute Crit Care. 2018;33(4):252-259. Published online November 30, 2018; DOI: https://doi.org/10.4266/acc.2018.00248; Correction in: Acute Crit Care 2019;34(1):99

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Abstract PDF

Background
The aim of this study was to investigate the effects of using a systematic approach to tracheostomy care by a clinical nurse specialist and surgical intensivists for patients with a tracheostomy who were transferred from the surgical intensive care unit (SICU) to the general ward.
Methods
In this retrospective study, subjects were limited to SICU patients with a tracheostomy who were transferred to the general ward. The study period was divided into a preintervention period (January 1, 2007 to December 31, 2010) and a postintervention period (January 1, 2011 to December 31, 2014), and electronic medical records were used to analyze and compare patient characteristics, clinical outcomes, and readmission to the SICU.
Results
The analysis included 44 patients in the preintervention group and 96 patients in the postintervention group. Decannulation time (26.7±25.1 vs. 12.1±16.0 days, P=0.003), length of stay in the general ward (70.6±89.1 vs. 40.5±42.2 days, P=0.008), length of total hospital stay (107.5±95.6 vs. 74.7±51.2 days, P=0.009), and readmission rate of SICU decreased due to T-cannula occlusion (58.8% vs. 5.9%, P=0.010).
Conclusions
Using a systematic approach to tracheostomy care in the general ward led to reduction in decannulation time through professional management, which resulted in a shorter hospital stay. It also lowered SICU readmission by solving problems related to direct Tcannula.

Citations

Citations to this article as recorded by

Quality tracheotomy care can be maintained for non‐COVID patients during the COVID‐19 pandemic
Jacqueline Tucker, Nicole Ruszkay, Neerav Goyal, John P. Gniady, David Goldenberg
Laryngoscope Investigative Otolaryngology.2022; 7(5): 1337. CrossRef
Global Tracheostomy Collaborative: data-driven improvements in patient safety through multidisciplinary teamwork, standardisation, education, and patient partnership
Michael J. Brenner, Vinciya Pandian, Carly E. Milliren, Dionne A. Graham, Charissa Zaga, Linda L. Morris, Joshua R. Bedwell, Preety Das, Hannah Zhu, John Lee Y. Allen, Alon Peltz, Kimberly Chin, Bradley A. Schiff, Diane M. Randall, Chloe Swords, Darrin Fr
British Journal of Anaesthesia.2020; 125(1): e104. CrossRef

Surgery
Feasibility of Percutaneous Dilatational Tracheostomy with a Light Source in the Surgical Intensive Care Unit: Jong-Kwan Baek, Jung-Sun Lee, Minchang Kang, Nak-Jun Choi, Suk-Kyung Hong; Acute Crit Care. 2018;33(2):89-94. Published online April 26, 2018; DOI: https://doi.org/10.4266/acc.2017.00563

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Abstract PDF

Background
Although percutaneous dilatational tracheostomy (PDT) under bronchoscopic guidance is feasible in the intensive care unit (ICU), it requires extensive equipment and specialists. The present study evaluated the feasibility of performing PDT with a light source in the surgical ICU.
Methods
The study involved a retrospective review of the outcomes of patients who underwent PDT with a light source performed by a surgery resident under the supervision of a surgical intensivist in the surgical ICU from October 2015 through September 2016. During the procedure, a light wand was inserted into the endotracheal tube after skin incision. Then, the light wand and the endotracheal tube were pulled out slightly, the passage of light through the airway was confirmed, and the relevant point was punctured.
Results
Fifty patients underwent PDT with a light source. The average procedural duration was 14.0 ± 7.0 minutes. There were no procedure-associated deaths. Intraoperative complications included minor bleeding in three patients (6%) and paratracheal placement of the tracheostomy tube in one patient (2%); these were immediately resolved by the surgical intensivist. Two patients required conversion to surgical tracheostomy because of the difficulty in light wand insertion into the endotracheal tube and a very narrow trachea, respectively.
Conclusions
PDT with a light source can be performed without bronchoscopy and does not require expensive equipment and specialist intervention in the surgical ICU. It can be safely performed by a surgical intensivist with experience in surgical tracheostomy.

Citations

Citations to this article as recorded by

Increasing the precision of simulated percutaneous dilatational tracheostomy—a pilot prototype device development study
Athia Haron, Lutong Li, Eryl A. Davies, Peter D.G. Alexander, Brendan A. McGrath, Glen Cooper, Andrew Weightman
iScience.2024; 27(3): 109098. CrossRef
The feasibility and safety of percutaneous dilatational tracheostomy without endotracheal guidance in the intensive care unit
Ji Eun Kim, Dong Hyun Lee
Acute and Critical Care.2022; 37(1): 101. CrossRef
Safety and feasibility of hybrid tracheostomy
Daeun Kang, In Beom Jeong, Sun Jung Kwon, Ji Woong Son, Gwan Woo Ku
Acute and Critical Care.2021; 36(4): 369. CrossRef

Thoracic Surgery
Safety of Surgical Tracheostomy during Extracorporeal Membrane Oxygenation: Hye Ju Yeo, Seong Hoon Yoon, Seung Eun Lee, Doosoo Jeon, Yun Seong Kim, Woo Hyun Cho, Dohyung Kim; Korean J Crit Care Med. 2017;32(2):197-204. Published online May 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00059

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Abstract PDF

Background
The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO.
Methods
From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST.
Results
Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×10⁹/L (range, 46 to 434 ×10⁹/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST.
Conclusions
The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.

Citations

Citations to this article as recorded by

Tracheostomy in Critically Ill COVID-19 Patients on Extracorporeal Membrane Oxygenation: A Single-Center Experience
Phillip Staibano, Shahzaib Khattak, Faizan Amin, Paul T. Engels, Doron D. Sommer
Annals of Otology, Rhinology & Laryngology.2023; 132(12): 1520. CrossRef
Does Tracheostomy Improve Outcomes in Those Receiving Venovenous Extracorporeal Membrane Oxygenation?
Joel C. Boudreaux, Marian Urban, Shaun L. Thompson, Anthony W. Castleberry, Michael J. Moulton, Aleem Siddique
ASAIO Journal.2023; 69(6): e240. CrossRef
Tracheostomy in high-risk patients on ECMO: A bedside hybrid dilational technique utilizing a Rummel tourniquet
Britton B. Donato, Marisa Sewell, Megan Campany, Ga-ram Han, Taylor S. Orton, Marko Laitinen, Jacob Hammond, Xindi Chen, Jasmina Ingersoll, Ayan Sen, Jonathan D'Cunha
Surgery Open Science.2023; 16: 248. CrossRef
Assessing Clinical Feasibility and Safety of Percutaneous Dilatational Tracheostomy During Extracorporeal Membrane Oxygenation Support in the Intensive Care Unit
Tae Hwa Hong, Hyung Won Kim, Hyoung Soo Kim, Sunghoon Park
Journal of Acute Care Surgery.2022; 12(1): 18. CrossRef
Retrospective analysis of open bedside tracheotomies in a German tertiary care university hospital
Maximilian Riekert, Matthias Kreppel, Philipp Schminke, Annelies Weckx, Joachim E. Zöller, Volker C. Schick
Journal of Cranio-Maxillofacial Surgery.2021; 49(2): 140. CrossRef
Otolaryngology during COVID-19: Preventive care and precautionary measures
Chen Zhao, Alonço Viana, Yan Wang, Hong-quan Wei, Ai-hui Yan, Robson Capasso
American Journal of Otolaryngology.2020; 41(4): 102508. CrossRef
Tracheostomy while on Extracorporeal Membrane Oxygenation: A Comparison of Percutaneous and Open Procedures
Ismael A. Salas De Armas, Kha Dinh, Bindu Akkanti, Pushan Jani, Reshma Hussain, Lisa Janowiak, Kayla Kutilek, Manish K. Patel, Mehmet H. Akay, Rahat Hussain, Jayeshkumar Patel, Chandni Patel, Yafen Liang, John Zaki, Biswajit Kar, Igor D. Gregoric
The Journal of ExtraCorporeal Technology.2020; 52(4): 266. CrossRef

Pulmonary
Percutaneous Dilatational Tracheostomy in Critically Ill Patients Taking Antiplatelet Agents: Sung Jin Nam, Ji Young Park, Hongyeul Lee, Taehoon Lee, Yeon Joo Lee, Jong Sun Park, Ho Il Yoon, Jae Ho Lee, Choon Taek Lee, Young Jae Cho; Korean J Crit Care Med. 2014;29(3):183-188. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.183

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Abstract PDF

BACKGROUND
Percutaneous dilatational tracheostomy (PDT) has been considered as an alternative to surgical tracheostomy in intensive care units (ICU), and is widely used for critically ill patients who need prolonged mechanical ventilation. Few studies have reported on PDT performed in critically ill patients taking antiplatelet agents. Our goals are to assess not only the feasibility and safety of PDT, but also bleeding complications in the patients receiving such therapy.
METHODS
In a single institution, PDTs were performed by pulmonologists at the medical ICU bedside using the single tapered dilator technique and assisted by flexible bronchoscopy to confirm a secure puncture site. From March 2011 to February 2013, the patients' demographic and clinical data, procedural parameters, outcomes and complications were analyzed and compared complications between patients taking antiplatelet agents and those not.
RESULTS
PDTs were performed for 138 patients; the median age was 72 years, mean body mass index was 20.3 +/- 4.8 kg/m2, and mean acute physiology and chronic health evaluation II score was 24.4 +/- 9.4. Overall, the procedural success rate was 100% and the total procedural time was 25 +/- 8.5 min. There were no periprocedural life-threatening complications, and no statistical difference in the incidence of bleeding complications between patients who had taken antiplatelet agents and those had not (p = 0.657).
CONCLUSIONS
PDT performed in critically ill patients taking antiplatelet agents was a feasible procedure and was implemented without additional bleeding complications.

Citations

Citations to this article as recorded by

Open tracheostomy in patients with dual platelet aggregation inhibitors
Lorena Zapata-Contreras, Carlos Eduardo Hoyos-Cuervo, María Cristina Florián-Pérez
Colombian Journal of Anesthesiology.2019; 47(3): 189. CrossRef
Safety of Percutaneous Dilatational Tracheotomy in Patients on Dual Antiplatelet Therapy and Anticoagulation
Enzo Lüsebrink, Konstantin Stark, Mattis Bertlich, Danny Kupka, Christopher Stremmel, Clemens Scherer, Thomas J. Stocker, Mathias Orban, Tobias Petzold, Nikolaus Kneidinger, Hans-Joachim Stemmler, Steffen Massberg, Martin Orban
Critical Care Explorations.2019; 1(10): e0050. CrossRef
Safety and Feasibility of Percutaneous Dilatational Tracheostomy in the Neurocritical Care Unit
Dong Hyun Lee, Jin-Heon Jeong
Journal of Neurocritical Care.2018; 11(1): 32. CrossRef
Comparison of outcomes between vertical and transverse skin incisions in percutaneous tracheostomy for critically ill patients: a retrospective cohort study
Sung Yoon Lim, Won Gun Kwack, Youlim Kim, Yeon Joo Lee, Jong Sun Park, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Young-Jae Cho
Critical Care.2018;[Epub] CrossRef

Pulmonary/Surgery
Safety and Feasibility of Percutaneous Dilatational Tracheostomy Performed by Intensive Care Trainee: Daesang Lee, Chi Ryang Chung, Sung Bum Park, Jeong Am Ryu, Joongbum Cho, Jeong Hoon Yang, Chi Min Park, Gee Young Suh, Kyeongman Jeon; Korean J Crit Care Med. 2014;29(2):64-69. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.64

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Abstract PDF

Background
Percutaneous dilatational tracheostomy (PDT) performed by an intensivist in critically ill patients is currently popular. Many studies support the safety and feasibility of PDT. However, there is limited data on the safety and feasibility of PDT performed by intensive care trainees.
Methods
To evaluate the safety and feasibility of PDT performed by intensive care trainees and to compare these with those performed by intensivists, we retrospectively analyzed the clinical characteristics and adverse events of all prospectively registered patients who underwent PDT by ICT or intensivists in intensive care units (ICUs) from August 2010 to August 2013.
Results
In the study period, 203 patients underwent PDT in ICUs; 139 (68%) by trainees and 64 (32%) by intensivists. There were no statistically significant differences in clinical characteristics including demographics, laboratory findings, and parameters of mechanical ventilation between the two groups. Procedure times and outcomes of the patients were not different between the two groups. The majority of complications observed in 24 hours after PDT were bleeding; however, there was no significant difference between the two groups (trainee 10.8% vs. intensivist 9.4%, p = 0.758). There was no procedure-related death in the two groups.
Conclusions
PDT performed by intensive care trainees was safe and feasible. However, further well-designed studies should be conducted to confirm our results.

Citations

Citations to this article as recorded by

Comparison of Conventional Surgical Tracheostomy and Percutaneous Dilatational Tracheostomy in the Neurosurgical Intensive Care Unit
Sungdae Lim, Hyun Park, Ja Myoung Lee, Kwangho Lee, Won Heo, Soo-Hyun Hwang
Korean Journal of Neurotrauma.2022; 18(2): 246. CrossRef
Prediction of successful de-cannulation of tracheostomised patients in medical intensive care units
Chul Park, Ryoung-Eun Ko, Jinhee Jung, Soo Jin Na, Kyeongman Jeon
Respiratory Research.2021;[Epub] CrossRef
Severe pain-related adverse events of percutaneous dilatational tracheostomy performed by a neurointensivist compared with conventional surgical tracheostomy in neurocritically ill patients
Yong Oh Kim, Chi Ryang Chung, Chi-Min Park, Gee Young Suh, Jeong-Am Ryu
BMC Neurology.2020;[Epub] CrossRef
Is percutaneous dilatational tracheostomy with bronchoscopic guidance better than without?
Jinsun Chang, Hong-Joon Shin, Yong-Soo Kwon, Yu-Il Kim, Sung-Chul Lim, Tae-Ok Kim
Acute and Critical Care.2020; 35(2): 127. CrossRef
Safety and feasibility of ultrasound-guided insertion of peripherally inserted central catheter performed by an intensive care trainee
Yongwoo Lee, Jeong-Am Ryu, Yong Oh Kim, Eunmi Gil, Young-Mok Song
Journal of Neurocritical Care.2020; 13(1): 41. CrossRef
Safety and Feasibility of Percutaneous Dilatational Tracheostomy Performed by a Neurointensivist Compared with Conventional Surgical Tracheostomy in Neurosurgery Intensive Care Unit
John Kwon, Yong Oh Kim, Jeong-Am Ryu
Journal of Neurointensive Care.2019; 2(2): 64. CrossRef
Safety and Feasibility of Percutaneous Dilatational Tracheostomy in the Neurocritical Care Unit
Dong Hyun Lee, Jin-Heon Jeong
Journal of Neurocritical Care.2018; 11(1): 32. CrossRef
Percutaneous Dilatational Tracheostomy in Critically Ill Patients Taking Antiplatelet Agents
Sung-Jin Nam, Ji Young Park, Hongyeul Lee, Taehoon Lee, Yeon Joo Lee, Jong Sun Park, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Young-Jae Cho
Korean Journal of Critical Care Medicine.2014; 29(3): 183. CrossRef
Is Percutaneous Dilatational Tracheostomy Safe to Perform in the Intensive Care Unit?
Jae Hwa Cho
Korean Journal of Critical Care Medicine.2014; 29(2): 57. CrossRef

Case Reports

Sedation with Dexmedetomidine during Tracheostomy in Severe Tracheal Stenotic Patients: Injung Jun, Kye Min Kim, Sang Seok Lee, Byung Hoon Yoo, Yoo Yong Lee, Yun Hee Lim, Se Jin Song, Mun Cheol Kim; Korean J Crit Care Med. 2013;28(4):314-317.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.314

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Abstract PDF

In patients with severely compromised airways, a tracheostomy is usually performed under local anesthesia. Dexmedetomidine can be a better choice of sedative for such patients because it causes minimal respiratory depression. We report two cases of patients with severe stenosis of the airways who underwent sedation with dexmedetomidine during tracheostomy under local anesthesia. In the first case, recurrent laryngeal cancer caused laryngeal stenosis, and the narrowest laryngeal width was less than 3 mm. In the second case, the tracheostomy opening site was narrowed to a diameter of 3.4 mm in a patient with a history of total laryngectomy. For both patients, sedation was induced by dexmedetomidine infusion and the tracheostomy was performed successfully under local anesthesia without any events. Dexmedetomidine seems to be an effective and safe sedative for tracheostomies in patients with critical airways. The management and implications of sedation with dexmedetomidine in the patients with severe stenotic airways are discussed.

Citations

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Dexmedetomidine and emergency front of neck access for acute stridor in advanced laryngeal carcinoma: Anesthetic challenges
Neelakshi Koul, Uma Hariharan, Amit Kumar, Nidhi Yadav, VijayKumar Nagpal
Journal of Indian College of Anaesthesiologists.2022; 1(1): 30. CrossRef
Comment contrôler les voies aériennes en présence de masses cervicomédiastinales ?
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A Case of Laryngeal Mask Airway-Assisted Percutaneous Dilatational Tracheostomy: Ji Young Park, Taehoon Lee, Hongyeul Lee, Jae Ho Lee, Choon Taek Lee, Young Jae Cho; Korean J Crit Care Med. 2013;28(3):184-186.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.184

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Abstract PDF: Percutaneous dilatational tracheostomy (PDT) is a widely used method to perform tracheostomy in the critical care medicine for patients who need prolonged mechanical ventilation. Traditionally, PDT has been facilitated by bronchoscopy via the endotracheal tube. However, there are risks for blocking the view of correct puncture site on the trachea or being extubated unintentionally, which lead to loss of the airway. These complications are possibly due to insufficient bronchoscopic visualizations via endotracheal tube during the procedure. Using laryngeal mask airways (LMA) during PDT may overcome these problems and could provide a safer alternative method with superior visualizations of the trachea and larynx. We report a case of percutaneous tracheostomy being performed successfully under bronchoscopy with LMA in the intensive care unit.

Original Articles

Safety and Feasibility of Percutaneous Tracheostomy Performed by Medical Intensivists: Hongseok Yoo, So Yeon Lim, Chi Min Park, Gee Young Suh, Kyeongman Jeon; Korean J Crit Care Med. 2011;26(4):261-266.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.261

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Abstract PDF

BACKGROUND
Tracheostomy is one of the most commonly performed surgical procedures in the intensive care unit (ICU). After its introduction, percutaneous dilatational tracheostomy (PDT) has been recognized in western countries as a reliable alternative to surgical tracheostomy. However, data on the safety and feasibility of PDT performed by medical intensivists are limited in Korea.
METHODS
To evaluate the safety and feasibility of PDT performed by medical intensivists and to compare with those of surgical tracheostomy (ST), we retrospectively analyzed the clinical characteristics of all prospectively registered patients who underwent either PDT or ST in medical ICU from December 2010 to July 2011.
RESULTS
A total of 81 patients underwent tracheostomy over the study period: PDT in 56 (69%) and ST in 25 (31%). One patient in whom major bleeding developed during PDT underwent ST as a substitute for PDT. There were no differences in the demographics, laboratory findings, and parameters of mechanical ventilation between the two groups. Procedure time was significantly shorter in the PDT group (20 [IQR 18-30] min) than that in the ST group (38 [27.5-57.5] min) (p < 0.001). The major complication observed in 24 hours after PDT was bleeding in 6 (11%) patients of the PDT group and 4 (16%) patients of the ST group (p = 0.489). However, surgical interventions for major bleeding were required in 2 patients who underwent.
CONCLUSIONS
PDT performed by medical intensivists was safe and feasible. However, immediate surgical assistance should be available when required.

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Safety and Feasibility of Percutaneous Dilatational Tracheostomy Performed by a Neurointensivist Compared with Conventional Surgical Tracheostomy in Neurosurgery Intensive Care Unit
John Kwon, Yong Oh Kim, Jeong-Am Ryu
Journal of Neurointensive Care.2019; 2(2): 64. CrossRef
Safety and Feasibility of Percutaneous Dilatational Tracheostomy in the Neurocritical Care Unit
Dong Hyun Lee, Jin-Heon Jeong
Journal of Neurocritical Care.2018; 11(1): 32. CrossRef
Is Percutaneous Dilatational Tracheostomy Safe to Perform in the Intensive Care Unit?
Jae Hwa Cho
Korean Journal of Critical Care Medicine.2014; 29(2): 57. CrossRef
Percutaneous Dilatational Tracheostomy in Critically Ill Patients Taking Antiplatelet Agents
Sung-Jin Nam, Ji Young Park, Hongyeul Lee, Taehoon Lee, Yeon Joo Lee, Jong Sun Park, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Young-Jae Cho
Korean Journal of Critical Care Medicine.2014; 29(3): 183. CrossRef
Safety and Feasibility of Percutaneous Dilatational Tracheostomy Performed by Intensive Care Trainee
Daesang Lee, Chi Ryang Chung, Sung Bum Park, Jeong-Am Ryu, Joongbum Cho, Jeong Hoon Yang, Chi-Min Park, Gee Young Suh, Kyeongman Jeon
Korean Journal of Critical Care Medicine.2014; 29(2): 64. CrossRef
A Case of Laryngeal Mask Airway-Assisted Percutaneous Dilatational Tracheostomy
Ji Young Park, Taehoon Lee, Hongyeul Lee, Jae Ho Lee, Choon-Taek Lee, Young-Jae Cho
Korean Journal of Critical Care Medicine.2013; 28(3): 184. CrossRef

Incidence of Pulmonary Aspiration in Patients with Tracheostomy: Keon Sik Kim, Dong Soo Kim, Wha Ja Kang, Young Kyu Choi, Ok Young Shin, Doo Ik Lee, Moo Il Kwon; Korean J Crit Care Med. 1999;14(2):161-166.

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Abstract PDF: BACKGOUND: Patients with tracheostomy tubes have altered glottic closure in deglutition that may result in aspiration and may cause dangerous pulmonary complication including bronchopneumonia and atelectasis. The incidence of pulmonary aspiration in patients with tracheosomy may be high but difficult to determine because investigators often apply different criteria. The present study was prepared to document the incidence of aspiration in patients with tracheostomy using a simple dye-marker test.
METHODS
Thirty six surgical and medical patients (14 male and 22 female) in ICU with tracheostomy tube (high volume, low pressure cuffed tube) were included in this study. Mental status (presence of response to verbal command), the presence of nasogastric tube and the presence of ventilatory support were recorded in each patients to evaluate the effect of these factors on the incidence of aspiration. 1% solution of methylene blue dye was applied on the both side of posterior tongue and then any evidence of the blue dye-marker obtained microscopically on secretion through the tracheostomy tube at every 2 hours during 72 hours was considered the positive evidence of aspiration.
RESULTS
Aspiration was detected by a positive methylene blue dye test in 11 of the 36 patients (30.5%) and average length of time before blue dye was obtained on tracheal secretion was 8.2 7.3 hours.The presence of response to verbal command, nasogastric tube and ventilatory support had no apparent effect on the incidence of aspiration.
CONCLUSIONS
This observation suggests that a simple test using dye-maker is helpful to detect aspiration in patients with tracheostomy. Tracheostomy should be done under discreet decision because the high incidence of aspiration in trcheostomized patients.

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