Modified translaryngeal tracheostomy for ventilator-dependent cardiac patients: A pilot of nonrandomized study

A significant proportion of ventilator-dependent cardiac patients need tracheostomy during intensive care unit (ICU) stay. Three different methods including traditional (surgical), percutaneous dilatation tracheostomy, translaryngeal tracheostomy (TLT), and classical Fantoni method have been developed. In this study, modified translaryngeal tracheostomy (MTLT) has been introduced to reduce and correct the technical difficulty of classical TLT through the larynx.

The patients hospitalized because of cardiac diseases whose stay in ICU and coronary care unit lasted longer than 3 weeks, and were consulted and advised for elective tracheostomy. Afterwards, MTLT was performed for all patients (the new method).

From the 159 patients, 64.2% were women. The mean age was 65.25 ± 14.35 years. There was no considerable hemorrhage (bleeding >5-10 mL). The mean values of arterial oxygen pressure, oxygen saturation, heart rate, systolic blood pressure, and a peak airway pressure before and after MTLT had a significant improvement (P < .05), which reflects a better hemodynamic state after tracheostomy. All of the tracheostomies (MTLT) were successful and without any complications. There was no considerable bleeding despite the high international normalized ratio levels.

Unlike the classical Fantoni method, this study indicates that using a new improved method of tracheostomy through larynx did not impose any difficulty on retrograde passage of guide wire and this procedure could be safely conducted on patients with coagulation disorders.