Impact of Pecrutaneous Tracheostomy on the Human Trachea in vivo
18 April 2018 (online)
I:Percutaneous dilatational tracheostomy (PDT) has gained increasing popularity among intensive care units. Despite the clear advantages, it does have limitations and risks. Most of the disadvantages stem from the decreased control over the technical aspects of the procedure, mainly due to limited exposure and decreased visualization of the trachea.
M:The aim of this study is to quantitively and qualitatively describe the effect of PDT on the trachea in vivo. Retrospective study of endoscopic video material from the clinic's archive was performed. The impact on the trachea was visually interpreted and summarized. Account was taken for the degree of narrowing of the tracheal lumen on pressure application, proximity and contact of the used instrument with the posterior tracheal wall and any visible traumatic consequences on the tracheal mucosa and cartilaginous skeleton. Three sets of instruments were examined, namely PercuTwist, Ciaglia and Griggs.
R:An average of 70% luminal narrowing was observed for the Ciaglia, 67% for the Griggs and 25% for the PercuTwist with 77, 25 and 0% rate of contact with the posterior wall, respectively. These indices were further differentially calculated for the stages of the procedure, relatively to the appearance of the instrument in the lumen: on pressure application, on first penetration and full penetration of the dilatator in the tracheal lumen. Injury of the trachea was observed in the Ciaglia and Griggs groups, e.g. laceration of the mucosa, fracture of tracheal cartilages.
C:The study results show significant luminal narrowing when applying pressure with the dilatator, significant amount of contact between the dilatator and the tracheal wall and visible injury. It suggests that PDT is a relatively traumatic procedure.