Normal view MARC view ISBD view

Using a Laryngeal Mask Airway During Percutaneous Dilatational Tracheostomy is Safe and Obviates the Need for Paralytics.

MedStar author(s):

Citation: Journal of Bronchology & Interventional Pulmonology. 26(3):179-183, 2019 Jul.PMID: 30741843Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Atracurium/aa [Analogs & Derivatives] | *Laryngeal Masks | *Neuromuscular Blocking Agents/ad [Administration & Dosage] | *Tracheostomy/mt [Methods] | Aged | Airway Extubation | Atracurium/ad [Administration & Dosage] | Cross-Sectional Studies | Female | Humans | Laryngeal Masks/ae [Adverse Effects] | Male | Middle Aged | Operative Time | Postoperative Complications/et [Etiology]Year: 2019 ISSN:

1948-8270

Name of journal: Journal of bronchology & interventional pulmonologyAbstract: BACKGROUND: Bedside percutaneous tracheostomy (PT) placement in critically ill patients is performed in a variety of ways, largely driven by institutional preference. We have recently transitioned to primarily extubating the patient and placing a laryngeal mask airway (LMA) before tracheostomy insertion in lieu of retracting the endotracheal tube (ETT) in place. This allows for lower sedative use and provides a superior view of the operative field. Here, we seek to describe the safety and efficiency of that approach.CONCLUSION: Replacing the ETT with an LMA before PT is equally safe, does not increase total procedural duration, and all but eliminates the need for paralytic agents.METHODS: This is a single-center cross-sectional study from 2014 to 2016 comparing patients who underwent PT with the ETT in place retracted to the proximal larynx versus those who were extubated and had a LMA placed. Procedural length, sedative totals, and safety outcomes were recorded.RESULTS: In total, 125 patients underwent PT during the study period, 75 via a LMA and 50 via existing ETT. There was no difference in procedural duration (LMA: 53.5+/-21.4 min vs. ETT: 50.4+/-16.8; P=0.41), total complications (LMA: 29.3% vs. 16%; P=0.09) or major complications (4% in both groups). Cisatracurium use was significantly lower in the LMA arm (LMA: 1.0+/-3.6 mg vs. ETT: 11.5+/-5.9 mg; P<0.01).All authors: Sanley M, Sonti R, Vinayak AOriginally published: Journal of Bronchology & Interventional Pulmonology. 2019 Feb 06Fiscal year: FY2020Fiscal year of original publication: FY2019Digital Object Identifier:

https://dx.doi.org/10.1097/LBR.0000000000000547

Date added to catalog: 2019-03-14

Holdings ( 1 )
Title notes ( 5 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	30741843	Available		30741843

BACKGROUND: Bedside percutaneous tracheostomy (PT) placement in critically ill patients is performed in a variety of ways, largely driven by institutional preference. We have recently transitioned to primarily extubating the patient and placing a laryngeal mask airway (LMA) before tracheostomy insertion in lieu of retracting the endotracheal tube (ETT) in place. This allows for lower sedative use and provides a superior view of the operative field. Here, we seek to describe the safety and efficiency of that approach.

CONCLUSION: Replacing the ETT with an LMA before PT is equally safe, does not increase total procedural duration, and all but eliminates the need for paralytic agents.

METHODS: This is a single-center cross-sectional study from 2014 to 2016 comparing patients who underwent PT with the ETT in place retracted to the proximal larynx versus those who were extubated and had a LMA placed. Procedural length, sedative totals, and safety outcomes were recorded.

RESULTS: In total, 125 patients underwent PT during the study period, 75 via a LMA and 50 via existing ETT. There was no difference in procedural duration (LMA: 53.5+/-21.4 min vs. ETT: 50.4+/-16.8; P=0.41), total complications (LMA: 29.3% vs. 16%; P=0.09) or major complications (4% in both groups). Cisatracurium use was significantly lower in the LMA arm (LMA: 1.0+/-3.6 mg vs. ETT: 11.5+/-5.9 mg; P<0.01).

English