Use of the 'Aretube' to facilitate ventilation during percutaneous tracheostomy.

摘要

To the Editor: During percutaneous tracheostomy, the endotracheal tube is usually withdrawn to a sub-glottic position, or replaced by a laryngeal mask airway. This procedure has disadvantages and risks including: air leaks with hypercarbia, hypoxia, bronchial inhalation, and accidental extubation. A new airway device, the "Aretube" (Figure) has been developed recently to address some of these difficulties. The Aretube provides ventilatory assistance through intubation limited to one part of the larynx. The Aretube has a proximal orifice, and a distal orifice with two cuffs, the first of which has a 20-mL capacity, situated 1 cm from the distal end. The second cuff has a 100-mL cacacity and is situated approximately 1 cm proximal to the first. For correct positioning, the first cuff is placed in a supraglottic position immediately above the vocal cords, while the second cuff (once inflated) is sited in the oropharynx, thus fixing the device while applying gentle pressure on the first cuff. When inflated, the first cuff exerts pressure around the glottis, ensuring a good seal.