000			03324nam a22005657a 4500
008			190314s20192019 xxu||||| |||| 00| 0 eng d
022			_a1948-8270
024			_a10.1097/LBR.0000000000000547 [doi]
040			_aOvid MEDLINE(R)
099			_a30741843
245			_aUsing a Laryngeal Mask Airway During Percutaneous Dilatational Tracheostomy is Safe and Obviates the Need for Paralytics.
251			_aJournal of Bronchology & Interventional Pulmonology. 26(3):179-183, 2019 Jul.
252			_aJ Bronchology Interv Pulmonol. 26(3):179-183, 2019 Jul.
252			_zJ Bronchology Interv Pulmonol. 2019 Feb 06
253			_aJournal of bronchology & interventional pulmonology
260			_c2019
260			_fFY2020
265			_saheadofprint
265			_sppublish
266			_d2019-03-14
268			_aJournal of Bronchology & Interventional Pulmonology. 2019 Feb 06
269			_fFY2019
520			_aBACKGROUND: 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.
520			_aCONCLUSION: 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.
520			_aMETHODS: 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.
520			_aRESULTS: 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).
546			_aEnglish
650			_a*Atracurium/aa [Analogs & Derivatives]
650			_a*Laryngeal Masks
650			_a*Neuromuscular Blocking Agents/ad [Administration & Dosage]
650			_a*Tracheostomy/mt [Methods]
650			_aAged
650			_aAirway Extubation
650			_aAtracurium/ad [Administration & Dosage]
650			_aCross-Sectional Studies
650			_aFemale
650			_aHumans
650			_aLaryngeal Masks/ae [Adverse Effects]
650			_aMale
650			_aMiddle Aged
650			_aOperative Time
650			_aPostoperative Complications/et [Etiology]
651			_aMedStar Washington Hospital Center
656			_aMedicine/Pulmonary-Critical Care
657			_aJournal Article
700			_aSonti, Rajiv
790			_aSanley M, Sonti R, Vinayak A
856			_uhttps://dx.doi.org/10.1097/LBR.0000000000000547 _zhttps://dx.doi.org/10.1097/LBR.0000000000000547
942			_cART _dArticle
999			_c4096 _d4096