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Retrosternal percutaneous tracheostomy: an approach for predictably impossible classic tracheostomy.

Biderman P, Weinbroum AA, Rafaeli Y, Raz E, Porat E, Wiesel O, Szold O - Crit Care Res Pract (2010)

Bottom Line: Percutaneous tracheostomy is a routine procedure in intensive care units.In cases of very low position of the larynx, cervical spine deformation, morbid obesity, or neck tumor, performance of the classic tracheostomy is inapplicable.It is a bedside applicable technique, that, however, requires caution to avoid hazardous vascular complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel.

ABSTRACT
Percutaneous tracheostomy is a routine procedure in intensive care units. In cases of very low position of the larynx, cervical spine deformation, morbid obesity, or neck tumor, performance of the classic tracheostomy is inapplicable. Retrosternal approach to tracheostomy in such 20 patients is herein reported. After preoperative neck computerized tomography to define the neck anatomy, a small suprasternal incision followed by a short retrosternal tissue dissection to expose the trachea was done; the trachea was then catheterized at the level of the 2nd ring in the usual tracheostomy manner. The immediate and late (≥6 months) outcomes were similar to that of the standard tracheostomy. Thus, percutaneous retrosternal tracheostomy is safe in patients with abnormal positioning of the trachea or neck constitution. It is a bedside applicable technique, that, however, requires caution to avoid hazardous vascular complications.

No MeSH data available.


Related in: MedlinePlus

CT of an obese patient. Due to the distance of the trachea from the anterior surface of the neck (>7 cm from the skin), the trachea could be reached reasonably easily and safely from a point under the sternum.
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Related In: Results  -  Collection


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fig2: CT of an obese patient. Due to the distance of the trachea from the anterior surface of the neck (>7 cm from the skin), the trachea could be reached reasonably easily and safely from a point under the sternum.

Mentions: Between 2004–2007 a total of 1,508 patients underwent either open tracheostomy or PCT in our institution, 21 of them were refuted the above and thus scheduled for retrosternal percutaneous tracheotomy (Figures 1 and 2). Retrosternal PCT was withheld in one patient at the last minute, because of the medial and high position of the innominate artery; he remained intubated and ventilated through an ETT. The anatomical landmarks could not be palpated and the cricoid or thyroid cartilages could not be identified in thirteen patients. The trachea could not be reached during an open tracheostomy in the other seven patients due to the position of the first tracheal ring under and behind the sternum. Two patients had more than one anatomical problem that impeded the performance of routine open tracheostomy. The procedure was halted in the above 7 patients who returned to the ward with their ETT. They then underwent CT-angio and based on the results all were referred to retrosternal PCT which was performed uneventfully.


Retrosternal percutaneous tracheostomy: an approach for predictably impossible classic tracheostomy.

Biderman P, Weinbroum AA, Rafaeli Y, Raz E, Porat E, Wiesel O, Szold O - Crit Care Res Pract (2010)

CT of an obese patient. Due to the distance of the trachea from the anterior surface of the neck (>7 cm from the skin), the trachea could be reached reasonably easily and safely from a point under the sternum.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2958601&req=5

fig2: CT of an obese patient. Due to the distance of the trachea from the anterior surface of the neck (>7 cm from the skin), the trachea could be reached reasonably easily and safely from a point under the sternum.
Mentions: Between 2004–2007 a total of 1,508 patients underwent either open tracheostomy or PCT in our institution, 21 of them were refuted the above and thus scheduled for retrosternal percutaneous tracheotomy (Figures 1 and 2). Retrosternal PCT was withheld in one patient at the last minute, because of the medial and high position of the innominate artery; he remained intubated and ventilated through an ETT. The anatomical landmarks could not be palpated and the cricoid or thyroid cartilages could not be identified in thirteen patients. The trachea could not be reached during an open tracheostomy in the other seven patients due to the position of the first tracheal ring under and behind the sternum. Two patients had more than one anatomical problem that impeded the performance of routine open tracheostomy. The procedure was halted in the above 7 patients who returned to the ward with their ETT. They then underwent CT-angio and based on the results all were referred to retrosternal PCT which was performed uneventfully.

Bottom Line: Percutaneous tracheostomy is a routine procedure in intensive care units.In cases of very low position of the larynx, cervical spine deformation, morbid obesity, or neck tumor, performance of the classic tracheostomy is inapplicable.It is a bedside applicable technique, that, however, requires caution to avoid hazardous vascular complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel.

ABSTRACT
Percutaneous tracheostomy is a routine procedure in intensive care units. In cases of very low position of the larynx, cervical spine deformation, morbid obesity, or neck tumor, performance of the classic tracheostomy is inapplicable. Retrosternal approach to tracheostomy in such 20 patients is herein reported. After preoperative neck computerized tomography to define the neck anatomy, a small suprasternal incision followed by a short retrosternal tissue dissection to expose the trachea was done; the trachea was then catheterized at the level of the 2nd ring in the usual tracheostomy manner. The immediate and late (≥6 months) outcomes were similar to that of the standard tracheostomy. Thus, percutaneous retrosternal tracheostomy is safe in patients with abnormal positioning of the trachea or neck constitution. It is a bedside applicable technique, that, however, requires caution to avoid hazardous vascular complications.

No MeSH data available.


Related in: MedlinePlus