IJCM  Vol.4 No.2 , February 2013
Percutaneous Dilational Tracheostomy in the Emergent Setting
ABSTRACT

Objective: Since its inception, the use of the percutaneous dilational tracheostomy (PDT) has been contraindicated in the setting of an emergent airway. Emerging in the literature are several cases of successful emergent PDTs. Here we present our experience with the use of PDT in managing emergent airways. Study Design: All patients who underwent emergent PDT, using the Ciaglia Blue Rhino Introducer Set (Cook Critical Care, Bloomington,IN), in an academic county hospital setting between February 2010 and May 2012 were included in the study. Electronic medical records were reviewed for demographic and procedural data. Results: Twelve patients were included in the study with ages ranging from 20 to 87 (mean 57) years-old. The most common reason for emergent airway was trauma (7 patients), followed by obstructing neck mass (2 patients), septic shock (2 patients), and angioedema (1 patient). Seven PDTs were performed in the OR, four at bedside and one in the ER. Three of the 12 patients had emergent cricothyroidotomies in place that malfunctioned, requiring emergent conversion. No patients suffered from short term complications. One patient developed a neck abscess at the site of the PDT one month post operatively, two patients had accidental decanulation post operatively, and both were replaced without complication. Conclusions: PDT can be used in the emergent setting in the hands of trained practitioners with minimal complications. A larger, prospective trial is needed to make conclusions regarding patient care.


Cite this paper
A. McCague and D. Wong, "Percutaneous Dilational Tracheostomy in the Emergent Setting," International Journal of Clinical Medicine, Vol. 4 No. 2, 2013, pp. 96-98. doi: 10.4236/ijcm.2013.42018.
References
[1]   [1] A. McCague, H. Aljanabi and D. T. Wong, “Safety Ana lysis of Percutaneous Dilational Tracheostomies with Bronchoscopy in the Obese Patient,” Laryngoscope, Vol. 122, No. 5, 2012, pp. 1031 1034. doi:10.1002/lary.22505

[2]   M. J. Ault, B. Ault and P. Ng, “Percutaneous Dilational Tracheostomy for Emergent Airway Access,” Journal of Intensive Care Medicine, Vol. 18, No. 4, 2003, pp. 222 226. doi:10.1177/0885066603254108

[3]   L. S. Jackson, J. W. Davis, K. L. Kaups, L. P. Sue, M. M. Wolfe, J. F. Bilello and D. Lemaster, “Percutaneous Tra cheostomy: To Bronch or not To Bronch—That Is the Question,” Journal of Trauma, Vol. 71, No. 6, 2011, pp. 1533 1536. doi:10.1097/TA.0b013e31823ba29e

[4]   N. Jonas, W. Mulwafu and J. Joubert, “Emergent Percu taneous Tracheostomy,” South African Journal of Science, Vol. 45, No. 3, 2007, pp. 105 106.

 
 
Top