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• W4387266985 abstract "SESSION TITLE: Old and New Treatments for Critical Illnesses SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: Tracheostomies are commonly performed on patients who have an upper-airway obstruction or require long-term airway management.1,2 While percutaneous dilatational tracheostomy (PDT) has been shown to be a safe technique for experienced operators, perioperative and postoperative complications can occur when inexperienced operators perform the technique.3 To potentially alleviate some of these issues, we propose an augmentation to the traditional PDT technique with the use of a tactical 2-Lumen high-intensity red LED pen light to assist with the localization and visualization of the second-third tracheal ring. CASE PRESENTATION: A 52-year-old female with cardiac and pulmonary complications presented post-cardiac arrest with ventricular tachycardia and pulseless electrical activity. She had a complicated hospital stay with multiple intubations and an inability to wean from the ventilator. The patient was taken to the operating room where she underwent the novel procedure of Philip-Thomas percutaneous tracheostomy. The patient was positioned supine and palpation of the cricoid cartilage identified the general area of insertion. Subsequently, a red pen light is strobed to transilluminate the skin just below this point. The bronchoscope is advanced to the blinking light, and a hypodermic needle is introduced in place of the pen light under direct visualization. Then, a larger needle is introduced adjacent to this previous needle, followed by removal of the hypodermic needle. The guide wire is inserted inferior to the needle, and the dilator is advanced over the guide wire to dilate the tract. A tracheostomy tube is placed over the guide wire, and the guide wire is removed. A confirmatory bronchoscopy is performed to visualize the carina from the tracheostomy tube. The tracheostomy tube was secured to the skin using sutures and a velcro strap. The procedure took about 11 minutes with less than 1 cc of blood loss and good hemostasis. The patient tolerated the procedure well and was back to minimal ventilator setting immediately. DISCUSSION: The red LED pen light provides visualization through the skin to the bronchoscope which allows operators to confirm the location of the second-third tracheal ring prior to making an incision, rather than using only blunt palpation as seen in traditional PDT. By making the incision after visualization with the red pen light, this may result in smaller incisions that can potentially reduce complication rates.In training new operators, this device may provide an easier and safer PDT technique to learn, which may improve the competency of operators. The addition of the red pen device to PDT also has minimal to no consequences as the procedure can be aborted at any time. CONCLUSIONS: Overall, this novel device potentially provides a safe improvement to the traditional PDT technique that may help improve inexperienced operator outcomes and reduce complications. REFERENCE #1: Barash, M., & Kurman, J. S. (2021). Patient selection and preoperative evaluation of percutaneous dilation tracheostomy in the intensive care unit. Journal of thoracic disease, 13(8), 5251–5260. https://doi.org/10.21037/jtd-2019-ipicu-18 REFERENCE #2: Johnson-Obaseki, S., Veljkovic, A. and Javidnia, H. (2016), Complication rates of open surgical versus percutaneous tracheostomy in critically ill patients. The Laryngoscope, 126: 2459-2467. https://doi.org/10.1002/lary.26019 REFERENCE #3: Mehta, C., & Mehta, Y. (2017). Percutaneous tracheostomy. Annals of cardiac anaesthesia, 20(Supplement), S19–S25. https://doi.org/10.4103/0971-9784.197793 DISCLOSURES: No relevant relationships by Stevin Lu No relevant relationships by Granlee Nguyen No relevant relationships by George Philip No relevant relationships by Dillon Wade" @default.
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• W4387266985 date "2023-10-01" @default.
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• W4387266985 title "PHILIP-THOMAS PERCUTANEOUS DILATATIONAL TRACHEOSTOMY: A NEW APPROACH TO A CLASSIC PROCEDURE" @default.
• W4387266985 doi "https://doi.org/10.1016/j.chest.2023.07.1722" @default.
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