I gel versus endotracheal intubation for percutaneous tracheostomies: a randomised study to ascertain amicable approach

Authors

  • S. P. Sharma Department of Anaesthesiology and Critical Care, Military Hospital, Jaipur, India
  • Anuj Singh Department of Anaesthesiology and Critical Care, Military Hospital, Jaipur, India http://orcid.org/0000-0003-1186-2063

DOI:

https://doi.org/10.18203/2349-2902.isj20213602

Keywords:

Percutaneous dilation tracheostomy, Guide wire, I gel, Critical care

Abstract

Background: Percutaneous tracheostomy or percutaneous dilation tracheostomy (PDT) is an airway management procedure routinely performed in critically ill patients, requiring prolonged ventilation. It is safely performed bedside by anaesthesiologist/intensivist in ICUs. Complications as endotracheal tube (ET) damage, loss of airway due to accidental extubation and piercing of guide wire through ET tube during procedure has led to exploration of safer/effective and viable airway alternatives while performing the procedures.

Methods: In this study we randomised 60 patients to group E (ET) and group I (I gel) 30 each and studied ease of carrying out procedure and associated complication rates in both groups.

Results: In ET group (group E), 9% of patients suffered with potentially catastrophic complications, e.g. loss of airway, inadequate ventilation of lungs, haemorrhage, airway leak due to ET tube cuff rupture and accidental extubation. In ETT group there was incidence of 18% cuff puncture by guide wire (p=0.025) and 3% accidental tracheal extubation. Group I witnessed lower incidence of haemorrhage (3%) and the incidence of guide wire piercing airway device was nil. Group I also demonstrated better hemodynamic stability attributed to lesser tissue trauma and airway manipulation.

Conclusions: This study demonstrates enhanced safety with usage of I gel for PCDT, with less complication, better hemodynamic stability and shorter procedure duration.

Author Biographies

S. P. Sharma, Department of Anaesthesiology and Critical Care, Military Hospital, Jaipur, India

Head Of Dept

Anuj Singh, Department of Anaesthesiology and Critical Care, Military Hospital, Jaipur, India

DEPT OF ANAESTHESIOLOGY AND CRITICAL CARE

References

Frost EA. Tracing the tracheostomy. Ann Otol Rhinol Laryngol. 1976;85:618-24.

Veenith T, Ganeshamoorthy S, Standley T, Carter J, Young P. Intensive care unit tracheostomy: a snapshot of UK practice. Int Arch Med. 2008;1(1):21.

Szmuk P, Ezri T, Evron S, Roth Y, Katz J. A brief history of tracheostomy and tracheal intubation, from the bronze age to the space age. Intensive Care Med. 2008;34(2):222-8.

Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report. Chest. 1985;87(6):715-9.

Raimondi N, Vidal MR, Calleja J, Quintero A, Cortés A, Celis E, et al. Evidence based guidelines for the use of tracheostomy in critically ill patients. J Crit Care. 2017;38:304-18.

Bodenham AR. Percutaneous dilational tracheostomy. Completing the anaesthetist’s range of airway techniques. Anaesthesia. 1993;48(2):101-2.

Tarpy JJ, Lynch L. The use of the laryngeal mask airway to facilitate the insertion of a percutaneous tracheostomy. Intensive Care Med. 1994;20(6):448-9.

Brimacombe J, Clarke G, Simons S. The laryngeal mask airway and endoscopic guided percutaneous tracheostomy. Anaesthesia. 1994;49(4):358-9.

Dexter TJ. The laryngeal mask airway: a method to improve visualisation of the trachea and larynx during fibreoptic assisted percutaneous tracheostomy. Anaesth Intensive Care. 1994;22(1):35-9.

Burrell T, Sampson B, Sundararajan K, Carter A. percutaneous dilatational tracheostomy consensus statement. ANZICS. 2014.

Pelosi P, Severgnini P. Tracheostomy must be individualized! Crit Care. 2004;8(5):322-4.

Huang CS, Chen PT, Cheng SH, Chen CK, Hsu PK, Hsieh CC, et al. Relative contraindications for percutaneous tracheostomy: from the surgeons’ perspective. Surg Today. 2014;44(1):107-14.

Madsen KR, Guldager H, Rewers M, Weber SO, Kbke‑Jacobsen K, Jensen R, et al. Danish Guidelines 2015 for percutaneous dilatational tracheostomy in the intensive care unit. Dan Med J. 2015;62(3):5042.

Plummer AL, Gracey DR. Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest. 1989;96(1):178-80.

Insel J, Weissman C, Kemper M, Askanazi J, Hyman AI. Cardiovascular changes during transport of critically ill and postoperative patients. Crit Care Med. 1986;14:539‑42.

Smith I, Fleming S, Cernaianu A. Mishaps during transport from the intensive care unit. Crit Care Med. 1990;18(3):278-81.

Delaney A, Bagshaw SM, Nalos M. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta‑analysis. Crit Care. 2006;10(2):55.

Higgins KM, Punthakee X. Meta‑analysis comparison of open versus percutaneous tracheostomy. Laryngoscope. 2007;117(3):447-54.

Putensen C, Theuerkauf N, Guenther U, Vargas M, Pelosi P. Percutaneous and surgical tracheostomy in critically ill adult patients: a meta‑analysis. Crit Care. 2014;18(6):544.

Al‑Ansari MA, Hijazi MH. Clinical review: percutaneous dilatational tracheostomy. Crit Care. 2006;10(1):202.

Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of ran- domised controlled trials: the QUOROM statement. quality of reporting of meta-analyses. Lancet. 1999;354(9193):1896-900.

Hazard PB, Garrett HE, Adams JW. Bedside percutaneous tracheostomy: experience with 55 elective procedures. Ann Thorac Surg. 1988;46:63-7.

Leinhardt DJ, Mughal M, Bowles B, Glew R, Kishen R, MacBeath J, et al. Appraisal of percutaneous tracheostomy. Br J Surg. 1992;79(3):255-8.

Winkler WB, Karnik R, Seelmann O, Havlicek J, Slany J. Bedside percutaneous dilational tracheostomy with endoscopic guidance: experience with 71 ICU patients. Intensive Care Med. 1994;20(7):476-9.

Friedman Y, Fildes J, Mizock B, Samuel J, Patel S, Appavu S, et al. Comparison of percutaneous and surgical tracheostomies. Chest. 1996;110(2):480-5.

Ambesh SP, Tripathi M, Kaushik S. Percutaneous dilatational tracheostomy: A prospective study in 45 Patients. J Anaesthesiol Clin Pharmacol. 1998;48(1):41-5.

Ambesh SP, Kaushik S. Percutaneous dilational tracheostomy: the Ciaglia method vs the Portex (correction of Rapitrach) method. Anesth Analg. 1998;87:556-61.

Crofts SL, Alzeer A, McGuire GP, Wong DT, Charles D. A comparison of percutaneous and operative tracheostomies in intensive care patients. Can J Anaesth. 1995;42(9):775-9.

Escarment J, Suppini A, Sallaberry M, Kaiser E, Cantais E, Palmier B, et al. Percutaneous tracheostomy by forceps dilation: report of 162 cases. Anaesthesia. 2000;55(2):125-30.

Day C, Rankin N. Laceration of the cuff of an endotracheal tube during percutaneous dilational tracheostomy. Chest. 1994;105(2):644.

Williams P, Warwick R. Gray’s anatomy. 36th ed. London: Churchill Livingstone; 1980: 1229.

Kim YB, Chang YJ, Jung WS, Byen SH, Yi Y. Application of PEEP using the i-gel during volume-controlled ventilation in anesthetized, paralyzed patients. J Anesth. 2013;27(6):827-31.

Brimacombe J, Berry A. Cricoid pressure and the LMA: efficacy and interpretation. Br J Anaesth. 1994;73(6):862-5.

Jadhav PA, Dalvi NP, Tendolkar BA. I-gel versus laryngeal mask airway-Proseal: Comparison of two supraglottic airway devices in short surgical procedures. J Anaesthesiol Clin Pharmacol. 2015;31(2):221-5.

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Published

2021-08-27

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Original Research Articles