Background and Goal of Study: Percutaneous dilational tracheostomy (PDT) is spreading as an alternative of conventional surgical tracheostomy in ICU. The use of endoscopic guidance during PDT is recommended to increase the safety of procedure. The aim of our study is to evaluate the use of the endotracheal view tube (ETview tube Ltd) instead of fiberoptic bronchoscopy (FBS) as an alternative endoscopic guide during PTD. Materials and Methods: We studied 10 consecutive adult patients scheduled for PDT in our general ICU of the University Hospital. Timing was 10 days (mean 9± SD 6,7). After informed consent was obtained, five patients underwent Ciaglia Blue Rhino tecnique (CBR) and five Percu-Twist (TW). Each PDT was performed under total intravenous anaesthesia (TIVA), myoresolution and pressure control ventilation. The ETview tube is a disposable endotracheal tube 7 or 8mm I.D. with video micro camera at the tip connected to a monitor (8 inch); it was placed by a tube exchange COOK n.11 O.D. 4.0 mm under continuous video-endoscopic control, before starting PDT. The tube exchange was left in trachea during the PDT to avoid dislodgment during the procedure. The meccanical ventilation support (PCV≤ 30cmH2O; PEEP≤ 10 cmH2O; Fr 15/m'; Ti ≤ 1.7"; FiO21) was continued using the ETview tube. Heart rate, oxygen saturation and arterial blood pressure were monitored. Results and Discussion: In all ten cases there were not clinically relevant complications: bleeding (> 5ml); posterior tracheal wall damage; tracheal ring fracture; pneumothorax; transitory hypoventilation; hypoxemia (SpO2‹95; PaO2: mean 126 ± SD 70,43 -min 67, max 226 mmHg-); hypercarbia; and no significant change in ABG from the baseline (Δ Ph 0,065, Δ PaO2 54mmHg, Δ PaCO2 8mmHg). The time required to perform PDT was: CBR 6.10 ± 2.10, TW 7.50 ± 3.05. Conclusion(s): ETview use to perform PDT is a safe and effective alternative at FBS. The continous video endoscopic view via portable screen or monitor allows the sharing, the learning of the whole staff and offers simplicity of use for less higly trained personnel. The ETview placement by a tube exchange enhances the safety of the procedure about the risk of the loss of airway control. The continuous endoscopic monitoring by ETview does not interfere with ventilation as the bronchoscopy via the endotracheal tube. Finally the use of ETview is easier, faster and chiper than video FBS. Citation: F. Ferraro, S. Tchikou, N. Foderini, O. Sagliocco, M. Chiefari. ETview tube for percutaneous endoscopic tracheostomy: Preliminary report. Eur J Anaesthesiol 2009; 26 (Suppl 45): 19AP7-8
ETview tube for percutaneous endoscopic tracheostomy: Preliminary report
FERRARO, Fausto;
2009
Abstract
Background and Goal of Study: Percutaneous dilational tracheostomy (PDT) is spreading as an alternative of conventional surgical tracheostomy in ICU. The use of endoscopic guidance during PDT is recommended to increase the safety of procedure. The aim of our study is to evaluate the use of the endotracheal view tube (ETview tube Ltd) instead of fiberoptic bronchoscopy (FBS) as an alternative endoscopic guide during PTD. Materials and Methods: We studied 10 consecutive adult patients scheduled for PDT in our general ICU of the University Hospital. Timing was 10 days (mean 9± SD 6,7). After informed consent was obtained, five patients underwent Ciaglia Blue Rhino tecnique (CBR) and five Percu-Twist (TW). Each PDT was performed under total intravenous anaesthesia (TIVA), myoresolution and pressure control ventilation. The ETview tube is a disposable endotracheal tube 7 or 8mm I.D. with video micro camera at the tip connected to a monitor (8 inch); it was placed by a tube exchange COOK n.11 O.D. 4.0 mm under continuous video-endoscopic control, before starting PDT. The tube exchange was left in trachea during the PDT to avoid dislodgment during the procedure. The meccanical ventilation support (PCV≤ 30cmH2O; PEEP≤ 10 cmH2O; Fr 15/m'; Ti ≤ 1.7"; FiO21) was continued using the ETview tube. Heart rate, oxygen saturation and arterial blood pressure were monitored. Results and Discussion: In all ten cases there were not clinically relevant complications: bleeding (> 5ml); posterior tracheal wall damage; tracheal ring fracture; pneumothorax; transitory hypoventilation; hypoxemia (SpO2‹95; PaO2: mean 126 ± SD 70,43 -min 67, max 226 mmHg-); hypercarbia; and no significant change in ABG from the baseline (Δ Ph 0,065, Δ PaO2 54mmHg, Δ PaCO2 8mmHg). The time required to perform PDT was: CBR 6.10 ± 2.10, TW 7.50 ± 3.05. Conclusion(s): ETview use to perform PDT is a safe and effective alternative at FBS. The continous video endoscopic view via portable screen or monitor allows the sharing, the learning of the whole staff and offers simplicity of use for less higly trained personnel. The ETview placement by a tube exchange enhances the safety of the procedure about the risk of the loss of airway control. The continuous endoscopic monitoring by ETview does not interfere with ventilation as the bronchoscopy via the endotracheal tube. Finally the use of ETview is easier, faster and chiper than video FBS. Citation: F. Ferraro, S. Tchikou, N. Foderini, O. Sagliocco, M. Chiefari. ETview tube for percutaneous endoscopic tracheostomy: Preliminary report. Eur J Anaesthesiol 2009; 26 (Suppl 45): 19AP7-8I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
