UNIPERCTM TRACHEOSTOMY KIT IN AN OBESE CRITICALLY ILL PATIENT

Aim. Tracheostomy is a technique for airway management commonly used in critically ill patients. The development of various percutaneous tracheostomy (PT) techniques has faci- litated the performance of this procedure by reducing the time of the procedure and improving the utilization of resour- ces1. The experience of the operator and clinical individual characteristics of the patient should be discriminative factors to choose the appropriated technique2. An optimal TS techni- que does not exist, but several reports indicate Ciaglia Blue Rhino kit used for obese patients in ICU. We report a PDT placement in an obese critically ill patient using the new Uni- percTM kit, it’s designed for difficult neck. Case report. A 65 yars old patient, BMI: 44 kg/m2, admitted in post operative ICU for lobectomy because of Pulmonary Cancer. He showed an important obstructive and restrictive Pulmonary Disease, mechanically ventilated by endotracheal tube. He was scheduled for video-assisted TS because of the weaning fail. Ultra sound study of the neck documented a measure of the tracheal-cutaneous tract was over 7 cm. So UnipercTM TS was chosen; it was performed in total intrave- nous anaesthesia (TIVA) as already described3. The neck was positioned in hyperextension. Antiseptic solution was applied to the operative site. An incision of approximately 8 mm on the skin overlying the site for tracheal puncture was made. With ultrasonography (US) guide the puncture site was loca- ted between the first and second tracheal ring. Following puncture with an extra long 14-G needle, the guidewire was introduced and the dilation process was performed with the UnipercTM single stage dilator. The dilator was advanced over the guidewire into the trachea up to the marking of 38 F external diameters. Once maximum dilation was achieved with the corresponding devicès mark visualized into the tra-cheal lumen by bronchoscopy, the UniPercTM Adjustable Flange Extended-Length Tracheostomy Tube was placed (Fig. 1). Discussion. Obesity has been considered a relative contrain- dication to the performance of PT because it can make diffi- cult to properly identify anatomical landmarks of the neck. Various authors have proposed the use of US guide as a com- plementary tool to avoid potential complications4. We chose a Uniperc kit with a dilator longer than the other PT devices because of pre-tracheal soft tissue (over 70 mm). This charac- teristic of UnipercTM dilator combined with US and endo- scopy allowed a successfully positioning of TS. Conclusions. Uniperc technique seem to be a safe procedure and suited to clinical characteristics of the obese pts. Howe- ver it would be appropriate to validate this experience with a statistically significant number of pts. References 1. Bardell T, Drover JW. Recent developments in percutaneous tracheostomy: improving techniques and expanding roles. Curr Opin Crit Care 2005;11:326- 32. 2. Pelosi P et al. Tracheostomy must be individualized! Crit Care 2004;8:322-4 3. Ferraro F et al. Assessment of ventilation during the performance of elective endoscopic-guided percutaneous tracheostomy: clinical evolution of a new method. Chest 2004;126:159-64. 4. Kollig E et al. Ultrasound and bronchoscopic controlled percutaneous tracheo- stomy on trauma UCI. Injury 2000;31:663-8.