Evaluation of percutaneous dilatational tracheostomy under laryngosuspension
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LARYNGOLOGY
Evaluation of percutaneous dilatational tracheostomy under laryngosuspension Mathieu Moulin1 · Marie‑Pierre Aboussouan2 · Paul F. Castellanos3 · Ihab Atallah1,4 Received: 11 May 2020 / Accepted: 16 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To describe the technique and outcomes of percutaneous tracheostomy under laryngosuspension. Methods 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 Forty-eight patients underwent percutaneous tracheostomy under laryngosuspension. Thirty-two cases were performed in an emergency after securing the airway with endotracheal intubation. In all other cases, tracheostomy was performed as a part of an elective procedure affecting the airway or in patients requiring prolonged ventilation. More than half of patients were considered high risk by virtue of one or more of the following: morbid obesity, prior neck surgery, prior neck radiotherapy, progressive head and neck cancer, or laryngotracheal stenosis. Complications occurred in seven cases. Conclusion Percutaneous tracheostomy under laryngosuspension has the advantage of optimal control of 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. Keywords Laryngosuspension · Tracheostomy · Percutaneous tracheostomy · Endoscopy · Airway
Introduction
Paul F. Castellanos and Ihab Atallah senior authors for this manuscript.
Tracheostomy is an ancient surgical procedure, described over 4000 years ago. Chevalier Jackson in the early twentieth century described a safer surgical technique with the addition of anesthesia and modern surgery [1]. This technique, performed through a cervical incision providing direct 2
Mathieu Moulin mmoulin5@chu‑grenoble.fr
Department of Anesthesiology and Intensive Care Medicine, Grenoble Alpes University Hospital, BP 217, 38043 Grenoble Cedex 09, France
3
Marie‑Pierre Aboussouan mpaboussouan@chu‑grenoble.fr
Otolaryngology‑Head and Neck Surgery, Northern Light Health Medical Center, Bangor, ME 04401‑3073, USA
4
School of Medicine, Grenoble Alpes University, Domaine de la Merci, BP 170 La Tronche, 38042 Grenoble Cedex 09, France
* Ihab Atallah iatallah@chu‑grenoble.fr
Paul F. Castellanos [email protected] 1
Otolaryngology‑Head and Neck Surgery Department, Grenoble
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