Intubated Patients, Percutaneous Tracheostomy
Conditions
Keywords
Tracheostomy, Critical care, Videolaryngoscopy, Direct laryngoscopy, Airway management
Brief summary
When preparing an ICU patient for percutaneous dilational tracheostomy, correct positioning of the endotracheal tube is important. During the procedure, it is possible to puncture the cuff. Tracheal tube cuff puncture can lead to failure of ventilation, loss of positive end-expiratory pressure, and possible aspiration of gastric contents blood or secretions. To minimize the risk, in our ICU, we withdraw the endotracheal tube under direct laryngoscopic vision until the cuff is visible at the vocal cords. This maneuver would also facilitate insertion of the Seldinger needle and insertion of the tracheostomy tube below the endotracheal tube. However, this maneuver to remove the endotracheal tube under direct laryngoscopy can sometimes be difficult. ICU patients present frecuently difficult laryngoscopic vision due to airway edema or secretions. In ICU, the videolaryngopy has been shown to be superior to direct laryngoscopy in visualization the upper airway, allowing better laryngoscopic vision.
Detailed description
The investigators aim to compare C-MAC videolaryngoscopy versus conventional direct laryngoscopy for positioning the tracheal tube to facilitate insertion of the Seldinger needle and the tracheostomy tube below the endotracheal tube during percutaneous tracheostomy.
Interventions
DEVICEC-MAC videolayngoscopy technique
Endotracheal tube will be removed before percutaneous tracheostomy using a C-MAC videolaryngoscopy.
DEVICELaryngoscopy technique
Endotracheal tube will be removed before percutaneous tracheostomy using a laryngoscopy
Sponsors
Hospital Clinico Universitario de Santiago
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Randomized, controlled.
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* ICU intubated patients that require a percutaneous dilational tracheostomy for clinical reasons (prolonged mechanical ventilation, airway protection or weaning failure).
Exclusion criteria
* Patients younger than 18 years and older than 85 years * Trachea and neck abnormalities. * Soft tissue infection in the neck. * History of neck surgery. * Coagulation disorders or changes in coagulation parameters (platelet count \< 50.000 mm3, an activated partial thromboplastin time 1.5-fold longer than the control value, and international normalized ratio \> 1.5). * Consent refusal for participating in the trial.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Introduction of the Seldinger needle below the endotracheal tube | during the procedure | Percentage of patients in whom the introduction of the Seldinger needle is below the tip of the endotracheal tube |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Puncture of the cuff of the endotracheal tube with the Seldinger needle | during the procedure | Percentage of patients suffering puncture the cuff of the endotracheal tube with the Seldinger needle |
| patients who need to remove the endotracheal tube to introduce the percutaneous tracheostomy cannula | during the procedure | Percentage of patients who need to remove the endotracheal tube to introduce the percutaneous tracheostomy cannula |
| Laryngoscopy vision using de Modified Cormack-Lehane grade of glottic view | during the procedure | Differences in laryngoscopy vision using de modified Cormack-Lehane grade of glottic view Modified Cormack-Lehane grade of glottic view: I: full view of the glottis (better outcome) IIa: partial view of the glottis IIb: arytenoid or posterior part of the vocal cords just visible III: only epiglottis visible IV: neither glottis nor epiglottis visible (worse outcome) |
| Difficulty of performing percutaneous tracheotomy | during the procedure | Differences in the difficulty of performing percutaneous tracheotomy Operator-assessed subjective difficulty of performing percutaneous tracheotomy: No difficulty, mild difficulty, moderate difficulty, severe difficulty. |
| Complications | during the ICU stay | Percentage of complications |
| Difficulty of removing the endotracheal tube | during the procedure | Differences in the difficulty of removing the endotracheal tube due to poor visualization, secretions.... Operator-assessed subjective difficulty of removing the endotracheal tube: No difficulty, mild difficulty, moderate difficulty, severe difficulty. |
Countries
Spain
Contacts
Primary ContactManuel Taboada, Ph.D.
Outcome results
None listed