A New Personal Percutaneous Tracheostomy Approach: A Preliminary Animal Study

摘要

Objectives: Percutaneous tracheostomy has been widely adopted for long-term airway management of critically ill patients. Currently, five different techniques are used; and the first two proposed, the original Ciaglia method and the Griggs forceps are still widely used. The aim of the study was to evaluate a new tracheotomy device and to determine possible advantages and complications. Methods: Six male farm pigs weighing 25 – 35 Kg were used for this study. The experiments have been conducted in accordance with national and international Laws and policies. The animals were anesthetized and percutaneously tracheotomized with the kit Mini Invasive Tracheostomy (kitMIT; X-med; Modena, Italy). One hour after the procedure, pigs were sacrificed and the trachea was checked for lesions. We evaluated the length of procedure, the difficulties in performing the procedure (Frova and Quintel classification), bleeding during the procedure, posterior tracheal wall damage, kinking of guide-wire, tracheal rings fracture, and para-tracheal insertion. Results: Mean time of procedure was 8.24 minutes. There were some difficulties in performing two procedures. Bleeding was absent in 4 pigs, and minimal in 2 pigs. There were no cases of posterior tracheal wall damage, no cases of tracheal rings fracture, and no cases of para-tracheal insertion of the device. In 2 cases, we observed kinking of the guide-wire. Conclusions: In this experimental study, the kitMIT allowed safe and easy percutaneous tracheostomies. The next experimental step will be a perspective human study. Disclosure Emilpaolo Manno has a financial interest in Mini Invasive Tracheostomy kit.Luca Bertolaccini, Alessandro Berra, and Silvia Burchielli have no financial interest in Mini Invasive Tracheostomy kit. The study was performed with the financial support of X-med (Modena, Italy). Introduction Percutaneous tracheostomy has now been widely adopted for the long-term airway management of critically ill patients and represents one of the most frequently performed surgical procedure in Intensive Care Unit (ICU). Currently, five different types of percutaneous techniques are used [1, 2, 3, 4]; and the first two proposed, the original Ciaglia method [1] and the Griggs forceps [2] are still widely used despite new approaches. This fact can mean, only, that ICU physicians are not completely satisfied with actually used techniques and the need for an improved dilatative technique is therefore obvious [5, 6, 7]. Actually, the percutaneous tracheostomies techniques do not use the available technologies as it has been done for example in cardiology, radiology, or endoscopy [8].The aim of the study was to evaluate a tracheotomy device; witch comprises a cannula that passes from a contracted status, inside a peel-away introducer, to an expanded status to dilatate neck tissues performing a tracheostomy. Methods And Materials The experiments has been conducted in accordance with national (Law n° 116/92, n° 8/July 94) and international Laws and policies (European Economic Community, Council Directive 86/609, December 1987). The animals were maintained in a pigpen for 1 to 3 days with free access to water and food pellets before enrolment. They were fasting the night before the procedure.All the procedures were performed by the authors, skilled in dilatative tracheostomy. Animal Preparation: After an overnight fast, the animal were anesthetized by an intramuscular injection of Zolazepam and Tiletamine (Zoletil ?, Virbac SA, Carros Cedex, France), 10 mg/kg and Atropine Sulphate (Atropine ?, Fisiopharma S.r.l. Italia, Milano, Italy), 0.05 mg/Kg. Afterward, it was placed in dorsal recumbence and monitorized for electrocardiographic features. Anesthesia was maintained by intravenous infusion of Propofol (Diprivan ?, Astrazeneca S.p.A., Basiglio (MI), Italy), 5 – 7 mg/kg/h. Procedure: A 1.0 cm longitudinal incision on the skin was done among first and second tracheal ring. A 14 Gauge (G) needle was use