The result of modified translaryngeal tracheostomy in ventilator - dependent cardiac patients

Advances and improvements in treatment of critical illnesses has resulted in more patients who require prolonged airway and ventilator support. Finally tracheostomy allows the patient to speak and eat and to become out of bed. Tracheostomy procedure can be done in three

conventional (surgery in operation room), percutaneous Dilatation (PDT) and Translaryngeal (TLT) in intensive car units. In this research we have introduced one new approach as a Modified approach for classic Fantoni method, that removes the technical difficulty of classic fantoni methods. It is reported that the classic approach has 31.1% difficulty in retrograde passage of guide wire from trachea to larynx and oral cavity.

A retrospective and cohort study was conducted on 159 patients that admitted with cardiac pathology in intensive care units of Rajaie Heart Hospital Iran-Tehran, because of different reasons. The duration of their hospitalization in Intensive Care Units was prolonged, So elective tracheostomy was indicated and modified approach of TLT was done for all of them.

Modified tracheostomy approach was done for all of the patients without any technical problems and complications. No bleeding was observed despite the 3.4>INR> 1.8. (Range of bleeding was 5- 10 ml). There were no singificant changes in clinical factors such as: PAO2, O2sat, HR, BP, Peak Inspiratory Pressure (PIP) and Hb.

We concluded that use of the new TLT technique (modification of classic fantoni method) removes difficulties in retrograde passage of guide wire through the larynx and mouth that is reported in classical fantoni method. We also reached to this conclusion that TLT is safe in cardiac patients with coagulopathy (2.8> INR > 1.8).