Document Detail


Laryngeal mask airway or endotracheal tube for percutaneous dilatational tracheostomy: a comparison of visibility of intratracheal structures.
MedLine Citation:
PMID:  20357150     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Some severe complications during percutaneous dilatational tracheostomy (PDT) may be related to poor visualization of tracheal structures. Subjectively, the bronchoscopical view obtained via a laryngeal mask airway (LMA) seems to be better than that obtained with an endotracheal tube (ETT). In this prospective, randomized study, we compared LMA and ETT as the ventilatory device during PDT mainly with respect to visualization of tracheal structures. The quality of ventilation and airway-related complications are also reported. METHODS: In this prospective, randomized study, PDT was performed using an LMA (n = 33) or an ETT (n = 30). Quality of ventilation and visualization of tracheal structures (thyroid, cricoid, and tracheal cartilages) were rated as follows: very good (1), good (2), difficult (3), and not possible (4) with LMA/ETT. A rating of 4 required the alternate airway. Groups were compared using the chi(2) test. RESULTS: Visualization of tracheal structures was better with the LMA: ratings were 1 or 2 in 94% of patients with an LMA, compared with 66% of patients with an ETT (P <0.05). Visual control during puncturing the trachea was 1 or 2 in 97% of patients using an LMA and 77% of patients for an ETT (P < 0.05). A rating of 4 was assigned to 1 patient with an LMA and to 3 patients with an ETT. Hemodynamic variables were similar in both groups. Blood gas analysis during PDT showed decreased Pao(2) in both groups, and increased Paco(2), which was more pronounced with an ETT compared with an LMA (59 +/- 14 mm Hg and 51 +/- 11 mm Hg [P < 0.05]). In the ETT group, 2 patients were extubated accidentally, and in another patient, the bronchoscope was damaged because of insufficient visualization of the tracheal puncture site. CONCLUSION: The LMA technique showed definite advantages regarding visualization of relevant tracheal structures and the dilation process compared with an ETT. This may be especially relevant in the hands of inexperienced intensivists and in cases of difficult patient anatomy where improved structural visualization optimizes operating conditions.
Authors:
Ulf Linstedt; Michael Zenz; Kirsten Krull; Dietrich H?ger; Andreas W Prengel
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  110     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-01     Completed Date:  2010-04-23     Revised Date:  2010-05-28    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1076-82     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Diako Hospital, Flensburg, Academic Teaching Hospital of the University of Kiel, Germany. linstedtul@diako.de
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Gas Analysis
Dilatation
Female
Hemodynamics / physiology
Humans
Intubation, Intratracheal* / adverse effects
Laryngeal Masks* / adverse effects
Male
Middle Aged
Monitoring, Intraoperative
Positive-Pressure Respiration
Prospective Studies
Respiratory Mechanics / physiology
Trachea / anatomy & histology*
Tracheostomy / methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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