Author(s)
Ihab Atallah, MD
Mathieu Moulin, MD
Paul Castellanos, MD
Affiliation(s)
Grenoble Alpes University Hospital;
Abstract:
Objective: To describe the technique and outcomes of percutaneous tracheostomy under laryngosuspension.
Method: A consecutive series of patients who underwent percutaneous tracheostomy under laryngosuspension were reviewed for outcomes. The procedure is performed under general anesthesia and laryngosuspension. An 8.5 oral endotracheal tube is inserted and the cuff is inflated in the supraglottis, allowing access to the whole trachea and subglottis. The tube is taped to the laryngoscope. A rigid endoscope is inserted in the endotracheal tube through a swivel connector connected to the tube and the ventilation circuit. Percutaneous tracheostomy kit is used to perform dilatational tracheostomy at the desired level of the trachea under direct visual endoscopic control.
Results: Fifty patients underwent percutaneous tracheostomy under laryngosuspension. Fourteen cases were performed in an emergency. In all other cases, tracheostomy was performed as a part of a scheduled procedure affecting the airway or in patients requiring prolonged ventilation. Seventy percent of patients were considered high risk by virtue of one or more of the following: morbid obesity, coagulopathy, prior neck surgery, prior neck radiotherapy, laryngotracheal stenosis, or high ventilator demands. No complications occurred.
Conclusion: Percutaneous tracheostomy under laryngosuspension has the advantage of optimal control of the patient ventilation and hemostasis throughout the procedure. High quality endoscopic vision and easy access to the airway under laryngosuspension allow tracheostomy to be performed with maximum safety.