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Cricoid palpability as a selection criterion for bedside tracheostomy
Omar F Husein1, Douglas D Massick
1Department of Otolaryngology, The Ohio State University, Columbus, OH, USA.
Summary
Palpable cricoid cartilage is a key indicator for safe bedside tracheostomy. This study found significantly fewer complications in patients with a palpable cricoid cartilage undergoing bedside procedures.
Area of Science:
- Critical Care Medicine
- Surgical Procedures
- Patient Safety
Background:
- Bedside tracheostomy offers convenience but requires careful patient selection.
- The role of specific anatomical landmarks in ensuring safety is crucial.
Purpose of the Study:
- To assess the value of cricoid cartilage palpability as a criterion for selecting patients for bedside tracheostomy.
- To compare complication rates between bedside and operating room tracheostomies.
Main Methods:
- A prospective trial involving 220 intubated patients undergoing elective tracheostomy.
- Patients were divided into two groups: those with palpable cricoid cartilage undergoing bedside tracheostomy and those undergoing operating room tracheostomy.
- Demographic data, anatomical features, and perioperative complications were recorded.
Main Results:
- Patients with a palpable cricoid cartilage had a significantly lower perioperative complication rate (2% vs. 22%, P < 0.001).
- No significant differences were found in cervical girth, mental-to-sternum distance, or thyroid-notch-to-sternum distance between groups.
- No significant demographic or procedural differences were noted between bedside and operating room tracheostomy cohorts.
Conclusions:
- Bedside tracheostomy is safe in carefully selected patients, with palpable cricoid cartilage being a significant selection criterion.
- Complication rates for open surgical tracheostomy at the bedside and in the operating room are defined.
- Findings support developing protocols for cost-effective, high-quality surgical airway management.