Percutaneous tracheostomy: a safe method for residency in ICU

[P-9149] PERCUTANEOUS TRACHEOSTOMY: A SAFE METHOD FOR RESIDENCY IN ICU Gaetano Castellano, Fausto Ferraro, Stella Lanza, Maria Manbelli, Clara Anello Belluomo. Department of Anesthesiological Surgical and Emergency Sciences – General ICU, Second University of Naples, Naples, Italy; S. Angelo dei Lombardi, Avellino; S. Angelo dei Lombardi, Avellino Teaching percutaneous dilatational tracheostomy in ICU requires very good training and a safe way to perform the technique that can help both the resident and the supervisor. We utilized for this pourpase a video-broncoscopy and e new method to ventilate so that we can have time and direct vision of the operating field while the trainees performs the procedure. Introduction Teaching percutaneous dilatational tracheostomy (PDT) in a teaching genaral ICU (accademic institution) is not always simple. We selected 3 senior resident that had variability degree of experience available to individual trainees, that went through a training program (workshop, direct visualization on the video, internet, manichin, ect. ) to learn how to perform PDT, all procedure were done with a video bronchoscopy and the new method of ventilation (F. Ferraro et. all chest 2005) with the pediatric tube; all procedure were under the supervesion of a senior anesthesiologist. The aim of our study was to assest if this technique would give the residents the best and safe way to perform PDT. Materials and Method: 30 adult patients after informed conset was obtained, they underwent PDT, all tracheostomy were performed at the bedside. 15 underwent Ciaglia Blue Rhino technique (CBR) and 15 Pecu-twist. 3 senior resident each perfomed 5 CBR and 5 Percutwist. Induction was carried out with propofol (2 mg/Kg) or midazolam (0.15 mg/Kg), fentanyl (2-4 mcg/Kg), and neuromuscular blockade with cisatracurium besilate. Heart rate, oxygen saturation and arterial blood pressure were continuously monitored. Each patient had an indwelling arterial catheter. Arterial blood gas samples were obtained before and after the procedure. Before starting the procedure, secretions were cleared by catheter suction. The patient was extubated and reintubated by a tube exchange or direct laryngoscopy, using a 220-245 mm-long, 4.0 mm I.D. pediatric, uncuffed endotracheal tube, (Tracheal Tube Ruscelit ® or Portex®).Ventilator settings were: 40 cm H2O of PCV, 25 breaths/min of respiratory rate (RR), 1.2 secs of inspiratory time (I/E 1:1), 0 cm H2O of positive end-expiratory pressure (PEEP), FiO2 of 1.0. Results In all 30 procedure there were no clinically relevant complications (bleeding, posterior tracheal wall damage, trachea ring fracture,false passage,pneumotorax, no hypoventilation, hypercapnia and no hypoxemia). Performing time from the incision of the skin to the introduction of the trachestomy tube was CBR (6.10 + 2.10 ) percutwist (7.50 ± 3.05) there was no desaturation (SpO2 < 95) in all patients and no significant change in ABG from the baseline. There was only 3 cannula insertion complication do to procedure specific. All positioning of the cannula was video controlled. Conclusion The video-bronchoscopy guidance and the new ventilation with the pediatric tube, allows the resident to perform the tracheostomy with a clear visualiation during the entire operating time and to have the broncoscope during the entire dilatational procedure so that the senior anestesiologist and other students can see every step of the technique. We belive this is a simple and safe way to teach and train residents to learn PDT. Date: Sunday, December 10, 2006 Session Info: Poster Presentation II: 2:00PM - 4:00PM (1400-1600) Presentation Time: 02:00 PM Close Window