Laryngeal Mask Airway Versus Endotracheal Intubation for Airway Management During Percutaneous Dilatational Tracheostomy

Yıl 2023, Cilt: 13 Sayı: 3, 555 - 560, 31.05.2023

Kemal Yetiş Gülsoy Burcu Ancın Semiha Orhan

https://doi.org/10.16899/jcm.1283829

Öz

Aim: Tracheostomy is a common procedure performed surgically or percutaneously due to prolonged intubation. During the procedure, airway safety can be ensured using a laryngeal mask airway (LMA) or an endotracheal tube (ETT). The aim of this study was to investigate the complications associated with the use of LMA and ETT during the tracheostomy procedure, operative time, and changes in blood gas parameters.
Materials and Methods: This study included patients admitted to the Intensive Care Units of Burdur State Hospital between 2019 and 2023. A total of 78 patients were divided into two groups: ETT (n=39) and LMA (n=39). Procedure-related complications, operative time, blood gas data were recorded from the patient files.
Results: There was no statistically significant difference between the LMA and ETT groups in terms of complications. There was also no statistically significant difference in postoperative values of PaCO2 between the groups (p<0.439). The analysis of pre- and post-tracheostomy PaO2 values indicated a decrease in both the LMA and ETT groups (p<0.001 for both). The comparison of the two groups by the duration of the tracheostomy procedure showed a statistically significant shorter operative time in the LMA group than in the ETT group (p<0.001).
Conclusion: Our study demonstrated no statistically significant difference between LMA and ETT in terms of complications and changes in blood gas parameters. Tracheostomy with LMA has advantages over ETT, fewer personnel requirements during the procedure, clear vision in bronchoscopy, and shorter operative time.

Anahtar Kelimeler

Percutaneous dilatational tracheostomy, laryngeal mask airway, blood gas, complication

Destekleyen Kurum

No

Proje Numarası

No

Teşekkür

No

Perkütan Dilatasyon Trakeostomisi için Hava Yolu Yönetiminde Laringeal Maske ve Endotrakeal Entübasyonun Karşılaştırılması

Öz

Amaç: Trakeostomi işlemi uzamış entübasyon nedeniyle cerrahi yada perkütan teknik kullanılarak yapılan bir işlemdir. Bu işlem sırasında hava yolu güvenliği laringeal maske (LMA) ya da endotrakeal tüp (ETT) ile sağlanmaktadır. Bu çalışmada trakeostomi işlemi esnasında LMA ve ETT kullanımının komplikasyonlarını, işlem süresini ve kan gazı verilerindeki değişimlerini incelmeyi amaçladık.
Gereç ve Yöntem: Çalışmaya 2019-2023 yılları arasında Burdur Devlet Hastanesi Yoğun Bakım Kliniklerinde yatan hastalar dahil edilmiştir. Çalışmaya dahil edilen 78 hasta; ETT (n=39) ve LMA (n=39) kullanılanlar olarak iki gruba ayrılmıştır. İşleme ait komplikasyonlar, işlem süreleri, hastaların kan gazı verileri hasta dosyalarından kaydedildi.
Bulgular: Gruplar arasında komplikasyonlar açısından istatistiksel fark bulunmadı. LMA ve ETT ile trakeostomi açılan gruplar arasında işlem sonrası PaCO2 değerlerinde istatiksel olarak anlamlı fark yoktu (p<0.439). Trakeostomi öncesi ve sonrası PaO2 değerleri değerlendirildiğinde, hem LMA ve hem de ETT gruplarında düşme olduğu görüldü (her ikisi için de) (p<0,001). Trakeostomi işlemi süreleri karşılaştırıldığında ise LMA grubunda sürenin ETT grubuna göre istatistiksel anlamlı olarak daha kısa olduğu görüldü (p<0,001).
Sonuç: Çalışmamızda komplikasyonlar ve kan gazında meydana gelen değişimler açısından LMA ve ETT arasında herhangi istatistiksel olarak bir fark olmadığı görülmüştür. LMA ile trakeostominin ETT ye göre işlem sırasında daha az personel ihtiyacı olması, bronkoskopide görüş netliği ve işlem süresinin daha kısa olması gibi avantajları vardır.

Anahtar Kelimeler

Perkütan dilatasyon trakeostomi, laringeal maske, kan gazı, komplikasyon

Proje Numarası

No

Kaynakça

• 1. Durbin CG, Perkins MP, Moores LK .Should tracheostomy be performed as early as 72 hours in patients requiring prolonged mechanical ventilation? Respir Care 2010;55(1):76-87.
• 2. Wang F, Wu Y, Bo L, et al. The timing of tracheotomy in critically ill patients under going mechanical ventilation: a systematic review and meta-analysis of randomized controlled trials. Chest 2011;140(6):1456-65.
• 3. Delaney A, Bagshaw SM, Nalos M. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis. Crit Care 2006;10(2):R55.
• 4. Cobean R, Beals M, Moss C, Bredenberg CE. Percutaneous dilatational tracheostomy. A safe, cost-effective bedside procedure. Arch Surg 1996;131(3):265-71.
• 5. Kollig E, Heydenreich U, Roetman B, Hopf F, Muhr G. Ultrasound and bronchoscopic controlled percutaneous tracheostomy on trauma ICU. Injury 2000;31(9): 663-8.
• 6. Cattano D, Abramson S, Buzzigoli S, et al. The use of the laryngeal mask airway during guide wire dilating forceps tracheostomy. Anesth Analg 2006;103(2):453-7.
• 7. Linstedt U, Möller F, Grote N, Zenzand M, Prengel A. Intubating laryngeal mask as a ventilatory device during percutaneous dilatational tracheostomy: a descriptive study. Br J Anaesth 2007;99(6):912-5.
• 8. Heffner JE. The role of tracheotomy in weaning. Chest 2001;120(6):477-81.
• 9. Yasar E, Donmez E, Gumus Demirbilek S. Use of proseal laringeal mask airway under bronchoscopy guidance during percutaneous dilatational tracheostomy. JARSS 2022;30(1):9-15.
• 10. Mallick A, Bodenham AR. Tracheostomy in critically ill patients. Eur J Anaesthesiol 2010;27(8): 676-82.
• 11. Verghese C, Rangasami J, Kapila A, Parke T. Airway control during percutaneous tracheostomy: pilot study with the intubating laryngeal mask airway. Br J Anaesth 1998;81(4):608-9.
• 12. Vargas M, Sutherasan Y, Antonelli M, et al. Tracheostomy procedures in the intensive care unit: an international survey. Critical Care 2015;13;19(1):291.
• 13.YaghoubiS , Massoudi N , Fathi M , Nooraei N , Khezri MB , Abdollah S .Performing Percutaneous Dilational Tracheostomy without using Fiberoptic Bronchoscope. Tanaffos 2020;19(1):60-65.
• 14. Araujoa JB, Anón JM, García de LorenzoA, et al. Late complications of percutaneous tracheostomy using the balloon dilation technique. Med Intensiva 2018;42(3):151-58.
• 15. De Leyn P, Bedert L, Delcroix M, et al. Tracheotomy: clinical review and guidelines. Eur J Cardiothorac Surg 2007;32(3):412-21.
• 16. Simon M, Metschke M, Braune SA, et al. Death after percutaneous dilatational tracheostomy: a systematic review and analysis of risk factors. Crit Care 2013;17(5):R258.
• 17. Fikkers BG, vanVeen JA, Kooloos JG, et al. Emphysema and pneumothorax after percutaneous tracheostomy: case reports and an anatomic study. Chest 2004;125(5):1805-14.
• 18. Kaiser E, Cantais E, Goutorbe P, Salinier L, Palmier B. Prospective randomized comparison of progressive dilational vs forceps dilational percutaneous tracheostomy. Anaesth Intensive Care 2006;34(1):51-4.
• 19. Epstein SK. Late complications of tracheostomy. Respir Care 2005;50(4):542-9.
• 20. Goldenberg D, Ari EG, Golz A, Danino J, Netzer A, Joachims HZ. Tracheotomy complications: a retro spective study of 1130 cases. Otolaryngol Head Neck Surg 2000;123(4):495-500.
• 21. Dosemeci L, Yilmaz M, Gürpinar F, Ramazanoglu A. The use of the laryngeal mask airway as an alternative to the endotracheal tube during percutaneous dilatational tracheostomy. Intensive Care Med 2002;28(1):63-7.
• 22. Dexter TJ. The laryngeal mask airway: a method to improve visualisation of the trachea and larynx during fiberoptic assisted percutaneous tracheostomy. Anaesth Intensive Care 1994;22(1):35-9.
• 23. Reilly PM, Sing RF, Giberson FA, et al. Hypercarbia during tracheostomy: a comparison of percutaneous endoscopic, percutaneous Doppler, and standard surgical tracheostomy. Intensive Care Med 1997;23(8):859-64.
• 24. Linstedt U, Zenz M, Krull K, Häger D, Prengel AW. Laryngeal mask airway or endotracheal tube for percutaneous dilatational tracheostomy: a comparison of visibility of intratracheal structures. Anesth Analg 2010;110(4):1076-82.
• 25. Zhang B, Chen C. Comparison of Ventilator-Associated Pneumonia and Surgical Site Infection between Two Methods of Tracheostomy. Comput Math Methods Med 2022;15:3186634.
• 26. Terragni PP, Antonelli M, Fumagalli R, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilate dadult ICU patients: a randomized controlled trial. JAMA 2010;303(15):1483-9.