Laryngorhinootologie 2006; 85(9): 628-632
DOI: 10.1055/s-2006-951404
Tipps + Tricks

© Georg Thieme Verlag KG Stuttgart · New York

Das Tracheotomie-Endoskop für Dilatationstracheotomien (TED)[*]

Tracheotomy-Endoscop for Dilatational Percutaneous Tracheotomy (TED)
Further Information

Publication History

Publication Date:
01 September 2006 (online)

 

Abstract

While surgical tracheotomies are currently performed using state-of-the-art operative techniques, percutaneous dilatational tracheostomy (PDT) is in a rapidly evolving state with regard to its technology and the number of techniques available. This has resulted in a range of new complications that are difficult to quantify on a scientific basis, given the fact that more than half of the patients who are tracheotomized in intensive care units die from their underlying disease. The new Tracheotomy Endoscope (TED) is designed to help prevent serious complications in dilatational tracheotomies and facilitate their management.

The endoscope has been specifically adapted to meet the require-ments of percutaneous dilatational tracheotomies. It is fully compatible with all current techniques of PDT. The method is easy to learn.

The percutaneous dilatational tracheotomy with the Tracheotomy Endoscope is a seven-step procedure:

  1. Introducing the endoscope into the larynx along the indwelling endotracheal tube.

  2. When the laryngeal structures have been identified, the endotracheal tube is removed. The endoscope is advanced into the trachea. From this point on, the patient is ventilated by jet ventilation or by direct manual bag ventilation through the Tracheotomy Endoscope.

  3. The trachea is visually inspected. The cricoid cartilage and the second through fourth tracheal rings can be clearly identified anteriorly for PDT.

  4. The optimal puncture site is marked by transillumination with a curved light carrier inserted through the endoscope. The trachea is punctured at the center of the light spot between the second and fourth tracheal rings. Large blood vessels in the anterior neck are clearly outlined by the transilluminating effect of the Tracheotomy Endoscope.

  5. Any commercially available dilation set, without exception, can be used for external dilation of the stoma site when the Tracheotomy Endoscope is used.

  6. A suitably-sized tracheostomy tube is inserted under endoscopic control, and ventilation is switched from the Tracheotomy Endoscope to the tracheostomy tube. Respiration is checked to confirm symmetrical ventilation.

  7. As the endoscope is withdrawn, the upper trachea and larynx are checked for any lesions caused by long-term intubation or PDT. Abnormalities in the form of granulations or polyps and displaced fracture fragments and tissue debris can be treated immediately under good endoscopic vision. This eliminates the risk that displaced fragments may become epithelialized and narrow the tracheal lumen.

Advantages of the Tracheotomy Endoscope:

Injuries to the posterior tracheal wall ar impossible (tracheoesophageal fistulas, pneumothorax).

Minor bleeding sites on the tracheal mucosa can be controlled with a specially curved suction-coagulation tube introudeced through the Tracheotomy Endoscope.

In cases with heavy bleeding and a risk of aspiration, the rigid indwelling Tracheotomy Endoscope provides a secure route for reintubating the patient with a cuffed endotracheal tube. It also allows for rapid conversion to an open surgical procedure if necessary.

All the parts are easy to clean and are autoclavable.

This type of endoscopically guided PDT creates an optimal link between the specialties of intensive care medicine and otorhinolaryngology.

The Tracheotomy Endoscope (TED) increases the standard of safety in PDT.

1 Auszugsweise vorgestellt auf der 77. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, 24.-28.05.2006 in Mannheim

Literatur

1 Auszugsweise vorgestellt auf der 77. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, 24.-28.05.2006 in Mannheim

Prof. Dr. Eckart Klemm

HNO-Klinik Krankenhaus Dresden-Friedrichstadt

Städtisches Klinikum,

Friedrichstr. 41

01067 Dresden