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Use of the Pro-Seal LMA facilitates percutaneous dilatational tracheostomy

L’utilisation du masque laryngé Pro-Seal facilite la trachéotomie dilatatrice percutanée

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Abstract

Purpose

To study the feasibility of using the Pro-Seal laryngeal mask airway (LMA) for airway maintenance during bronchoscopic guided percutaneous tracheostomy.

Methods

Observational study of 23 patients in an 11-bed general intensive care unit. The patient’s tracheal tube was exchanged for a Pro-Seal LMA before undertaking percutaneous tracheostomy.

Results

Inspiratory pressure and tidal volumes achieved during the procedure were recorded. The median peak inspiratory pressure was 25 (standard deviation 4.2) cm H2O. There was no loss of tidal volume in 11 patients, a loss of less than 100 mL·breath-1 in 11, and loss of more than 100 mL in one. A Pro-Seal LMA successfully maintained the airway and allowed adequate ventilation during percutaneous tracheostomy in all 23 patients. In all patients bronchoscopy through the Pro-Seal LMA provided a clear view of the cords and trachea and there was no laryngeal or tracheal soiling at any stage of the procedure.

Conclusion

The Pro-Seal LMA provides a reliable airway and allows effective ventilation during percutaneous tracheostomy. The passage of a fibrescope through the Pro-Seal LMA and glottis is easy and provides a clear view of the upper trachea.

Résumé

Objectif

Étudier la faisabilité de l’utilisation du masque laryngé (ML) Pro-Seal pour maintenir la perméabilité des voies aériennes pendant la trachéotomie percutanée à guidage bronchoscopique.

Méthode

L’étude par observation comportait 23 patients d’une unité de soins intensifs généraux. Un ML Pro-Seal a remplacé le tube trachéal avant la trachéotomie percutanée.

Résultats

La pression inspiratoire et les volumes courants obtenus pendant l’intervention ont été notés. La moyenne de la pression inspiratoire maximale a été de 25 cm H2O (écart type de 4,2). II n’y a pas eu de perte de volume courant chez 11 patients. Une perte de moins de 100 mL·respiration-1 a été notée chez 11 patients et une perte de plus de 100 mL chez un patient. Le ML Pro-Seal a maintenu avec succès la perméabilité des voies aériennes et permis une ventilation adéquate pendant la trachéotomie percutanée chez les 23 patients. Chez tous, la bronchoscopie réalisée en passant par le ML Pro-Seal a offert une vision claire des cordes vocales et de la trachée, sans contamination laryngée ou trachéale tout au long de l’intervention.

Conclusion

Le ML Pro-Seal assure la perméabilité des voies aériennes et permet une ventilation efficace pendant la trachéotomie percutanée. Le passage du fibroscope par le ML Pro-Seal et la glotte est facile et permet de visualiser clairement la trachée supérieure.

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Author information

Correspondence to Jerry P. Nolan.

Additional information

Disclosure statement: TM Cook has received a small honorarium for a lecture delivered on behalf of Intavent.

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Craven, R.M., Laver, S.R., Cook, T.M. et al. Use of the Pro-Seal LMA facilitates percutaneous dilatational tracheostomy. Can J Anaesth 50, 718 (2003). https://doi.org/10.1007/BF03018716

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Keywords

  • Tidal Volume
  • Tracheal Tube
  • Laryngeal Mask Airway
  • Percutaneous Dilatational Tracheostomy
  • Percutaneous Tracheostomy