Percutaneous tracheostomy in intensive care patients. Practicability and early complications of the translaryngeal Fantoni technique

Tracheostomy is considered the airway management of choice in long-term Ven tilated ICU palients. In the last few years, percutaneous dilatational trac heostomy (PDT) has been established as an attractive and safe alternative t o conventional open tracheostomy. Recently,there is another percutaneous te chnique according to Fantoni with translaryngeal airway access (TLT) availa ble. Our study seeks to evaluate TLT in terms of complications and practica bility. In 47 patients of our surgical ICU, elective TLT was performed. Mea n operative time was 9.8+/-10.9 (range 6-27) minutes. Severe complications, such as bleeding,aspiration or infection of the tracheostoma have never be en noted. A slight detoriation of arterial oxygen tension occured in 25 pat ients intraoperatively, demanding to rise the concentration of inspired oxy gen temporarily. However, no patient became hypoxic during the procedure. S ince during the procedure gas exchange may worsen,TLT should not be employe d in patients whose inspired oxygen concentration exceeds 80%. Despite the fact that severe complications associated with TLT have recently not yet be en reported, physicians who perform TLT should be well-trained in the techn ique of conventional open tracheostomy, too. According to our present data, TLT seems to be an attractive and safe alternative to PDT. Nevertheless, fo r a definiteve evaluation of TLT, further investigations in larger groups o f patients and in the long term seem to be necessary.