[Translarnygeal tracheostomy (TLT). A variant technique for use in hypoxemic conditions and in the difficult airway].

AIM

To prepare a variation to the original Fantoni technique for the purpose of performing a translaryngeal tracheostomy (TLT) without the need for repeated endotracheal intubation operations, neck movements and phases of apnea, in order to make this technique practicable and completely safe in the case of patients who are difficult to intubate, have cervical rachis injuries or suffer from serious hypoxemia.

SETTING

Multi-purpose intensive care.

PATIENTS

Fourteen patients (18-79 years old) to undergo tracheostomy, suffering from various limitations contraindicating the performance of a TLT according to the original Fantoni technique. OPERATION: Distinctive elements of the illustrated technique are: 1) the use of a fiber-bronchoscope in place of the rigid tracheoscope; 2) the insertion into the trachea of a particular guidewire, with J-shaped tip, placed on the outside of the artificial airway; 3) the use of a small-diameter endotracheal tube positioned coaxially to the original airway, to ventilate the patient during the introduction of the tracheostomy tube.

RESULTS

TLT was performed on 13 patients. In one case it was not performed because of the impossibility of introducing the thin endotracheal tube in the original artificial airway. No problems, complications or SatO2 reductions occurred during operations.

CONCLUSIONS

The variation presented is a safe and easy-to-perform technique considered advantageous in the case of TLTs performed on patients suffering from serious hypoxemia, who are difficult to intubate or have cervical rachis injuries.