Suspension Laryngoscopy-Assisted Percutaneous Dilatational Tracheostomy in High-Risk Patients

Objectives/Hypothesis: To describe the outcomes of bedside percutaneous dilatational tracheostomy (PDT) extended to the care of high-risk patients in the intensive care unit (ICU) by the use of suspension laryngoscopy (SL) to secure the airway. Study Design: Retrospective chart review. Methods: The records of 117 consecutive patients. who underwent suspension laryngoscopy-assisted percutaneous dilatational tracheostomy (SL:PDT) between April 2006 and May 2009 at our institution were reviewed. Data gathered included patient demographics, anatomical conditions, ventilator settings, intraoperative findings, presence of coagulopathy or anti-coagulation, and outcomes. Results: One hundred seven teen patients underwent SL-PDT. Eighty (68%) were considered nigh risk by virtue of one or more of the following: morbid obesity, coagulopathy, prior neck surgery or head and neck trauma, laryngotracheal stenosis or tracheomalacia, a high-riding innominate artery, or high ventilator demands. Thirty-five patients (30%) :had two or more of these risk factors. A total of 11 (13.7 %) complications occurred in the high-risk group. Two major and nine minor complications occurred during the study. There were no adverse sequelae. Conclusions: SL-PDT is a safe and effective means of bedside airway management in critically ill patients. This new technique offers several advantages over traditional percutaneous dilatational tracheostomy (T-PDT) and can be safely employed by otolaryngologists, especially in high-risk patients. This is most useful when T-PDT is considered untenable or when transport to the operating room for a standard open tracheostomy is considered too cumbersome or potentially dangerous.