Fiberoptic bronchoscopic guidance in percutaneous dilational tracheotomy

ObjectiveBlind percutaneous dilational tracheotomy (PDT) holds a lot of peri-operative complications. A lot of assisting tools have long been used to facilitate guidance during PDT, e.g., laryngeal mask airway (LMA), ultrasound (US) imaging of the neck, light wand for trans-illumination of the soft tissues of the neck, and flexible fiberoptic bronchoscopy. The aim of this work was to compare between blind and fiberoptic bronchoscopic guided PDT as regards ease of the technique and complications of the procedure.DesignA randomized prospective comparative trial.SettingCritical care department, main Alexandria university hospital.PatientsThirty adult patients, requiring elective PDT, and need to maintain a secure airway.MethodsThey were randomly assigned to 2 groups; blind PDT group I and fiberoptic bronchoscopic guided PDT group II. Both groups used Griggs’ forceps technique for PDT. Post-operative complications were recorded. End point was 48-h after the procedure.ResultsNumber of trials was 1.27 ± 0.46 and 1.00 ± 0.00 for groups I and II, respectively. Success rate was 100% in both groups. Procedural duration (in minutes) was 2.93 ± 1.10 in group I versus 3.93 ± 1.10 in group II. Bleeding was found in 3 patients and 1 patient for groups I and II. Subcutaneous emphysema occurred in one patient in each group, while tube misplacement was recorded in 2 patients in group I and none in group II. Aspiration pneumonia was found in 2 patients in group I and none in group II.ConclusionUse of flexible bronchoscopy has succeeded in decreasing the number of trials of needle insertion and decreasing the incidence of overall complications, while blind technique was better in shortening procedural time and avoidance of hypercapnia.