A NON-DERIVATIVE, NONSURGICAL TRACHEOSTOMY - THE TRANSLARYNGEAL METHOD

Objective: To present a new technique for non-surgical tracheostomy. D esign: An open, clinical trial on patients requiring elective tracheos tomy. Setting: Intensive care unit of a community hospital. Patients: 95 adults, mean age 60 years, and 14 infants and children, mean age 26 months (2 months-7 years) with common indications for tracheostomy In tervention: Through a needle inserted in the trachea, a guidewire is p ushed out of the mouth against the usual direction and attached to a s pecial device formed by a flexible plastic cone with a pointed metal t ip joined to an armoured tracheal cannula. This device is then pulled back through the oral cavity, larynx and trachea and outwards across t he neck wall by the operator applying traction on the wire with one ha nd and counterpressure on the neck wall with the fingers of the other hand. When the cone and a part of the cannula have emerged, the cannul a is cut off from the cone, straightened perpendicular to the skin, ro tated and advanced caudally to its final position. Results: The cone-c annula passed smoothly through the vocal cords. The metallic point per forated the neck easily. The dilation did not present any risk of trac heal wall damage because the direction of the manoeuvre was from the i nside to the outside of the neck. The tissues tightly adhered to the c annula, thus avoiding infection and bleeding. The use of ventilation s ystems permitted utilization of translaryngeal tracheostomy (TLT) even in patients for whom apnoea might have carried some risk, because the re is no interruption of respiratory assistance during the procedure. Followup showed no late obstructive complication at the level of the t racheostoma. Conclusions: By virtue of its greater safety and less tra uma to tissues than percutaneous techniques, TLT can also be carried o ut in infants and children (an important benchmark for any tracheostom y technique) and in very difficult patients from whom other techniques have serious drawbacks.