Evaluation of percutaneous dilatational tracheostomy under laryngosuspension

Abstract

Purpose: To describe the technique and outcomes of percutaneous tracheostomy under laryngosuspension.

Methods: A consecutive series of patients who underwent percutaneous tracheostomy under laryngosuspension were reviewed for outcomes. The procedure is performed under general anesthesia and laryngosuspension. An 8.5 oral endotracheal tube is inserted and the cuff is inflated in the supraglottis, allowing access to the whole trachea and subglottis. The tube is taped to the laryngoscope. A rigid endoscope is inserted in the endotracheal tube through a swivel connector connected to the tube and the ventilation circuit. Percutaneous tracheostomy kit is used to perform dilatational tracheostomy at the desired level of the trachea under direct visual endoscopic control.

Results: Forty-eight patients underwent percutaneous tracheostomy under laryngosuspension. Thirty-two cases were performed in an emergency after securing the airway with endotracheal intubation. In all other cases, tracheostomy was performed as a part of an elective procedure affecting the airway or in patients requiring prolonged ventilation. More than half of patients were considered high risk by virtue of one or more of the following: morbid obesity, prior neck surgery, prior neck radiotherapy, progressive head and neck cancer, or laryngotracheal stenosis. Complications occurred in seven cases.

Conclusion: Percutaneous tracheostomy under laryngosuspension has the advantage of optimal control of patient ventilation and hemostasis throughout the procedure. High-quality endoscopic vision and easy access to the airway under laryngosuspension allow tracheostomy to be performed with maximum safety.

Keywords: Airway; Endoscopy; Laryngosuspension; Percutaneous tracheostomy; Tracheostomy.

Fig. 1

Percutaneous dilatational tracheostomy under laryngosuspension. a Patient is placed in rigid suspension and intubated through the laryngoscope with an 8.5 endotracheal tube. The patient is ventilated throughout the procedure via the side port. b A rigid telescope inserted into the endotracheal tube offers high quality endoscopic vision throughout the entire procedure