Retrosternal Percutaneous Tracheostomy: An Approach for Predictably Impossible Classic Tracheostomy

摘要

Percutaneous tracheostomy is a routine procedure in intensive careunits. In cases of very low position of the larynx, cervical spinedeformation, morbid obesity, or neck tumor, performance of theclassic tracheostomy is inapplicable. Retrosternal approach totracheostomy in such 20 patients is herein reported. Afterpreoperative neck computerized tomography to define the neckanatomy, a small suprasternal incision followed by a shortretrosternal tissue dissection to expose the trachea was done; thetrachea was then catheterized at the level of the 2nd ring in theusual tracheostomy manner. The immediate and late (≥6 months) outcomes were similar to that of the standard tracheostomy. Thus,percutaneous retrosternal tracheostomy is safe in patients withabnormal positioning of the trachea or neck constitution. It is abedside applicable technique, that, however, requires caution toavoid hazardous vascular complications.