Assessment of Ventilation During the Performance of Elective Endoscopic- Guided Percutaneous Tracheostomy* Clinical Evaluation of a New Method

Study objectives: To evaluate the feasibility of uninterrupted translaryngeal open ventilation delivered through a pediatric, uncuffed endotracheal tube during percutaneous endoscopic tracheostomy (PET). Design and setting: Prospective, observational clinical study in a six-bed ICU of a university hospital. Patients: Forty consecutive adult patients requiring an elective tracheostomy. Interventions: We employed the basic Ciaglia technique with multiple dilators (n * 10), a single dilator (n * 15), and the Fantoni method (n * 15). During PET, pressure-controlled ventilation was maintained through an uncuffed, 4-mm inner-diameter pediatric tube. The fraction of inspired oxygen was 1.0. Ventilator settings were as follows: pressure-controlled ventilation, 40 cm H2O; respiratory rate, 25/min; inspiratory time, 1.2 s of inspiratory time (inspiratory/expiratory ratio, 1:1); and positive end-expiratory pressure, 0 cm H2O. Measurements and results: Measurements of arterial blood gas (ABG) tensions were obtained before the start of each tracheostomy and every 3 min during the procedure. An average of 8.28 * 2.28 ABG measurements were obtained from each patient (* SD). All patients were successfully assisted during performance of the tracheostomy, and no patient required ventilation through a cuffed endotracheal tube. The maximum increase in PaCO2 was 8.49 * 5.50 mm Hg, and the maximum decrease in pH related to hypercarbia was 0.04 * 0.04. The PaO2 increased in all patients (maximum change, 69.75 * 57.00 mm Hg; p < 0.01), and no patient had desaturation during the procedure. Conclusions: The technique that we propose for airway management during PET was safe and effective. A mild increase in PaCO2 was not associated with significant metabolic and hemodynamic consequences, and an adequate PaO2 was maintained throughout the study.