i nfra - glottic invasive airways dr. s.a.rajkumar, intensivist, tirunelveli
TRANSCRIPT
![Page 1: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/1.jpg)
INFRA-GLOTTIC
INVASIVE AIRWAYS
Dr. S.A.Rajkumar, Intensivist, Tirunelveli.
![Page 2: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/2.jpg)
INTRODUCTION
Airway access can be Supra-Glottic Infra-Glottic
Routine ET intubation is by supra-glottic
Alternative access to airway includes supra-glottic and infra-glottic access
2010KAN ISAC O
N
K A N IS A C ON
20 10
![Page 3: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/3.jpg)
DEFINITIONSupra-Glottic airway access
Access to the airway by any means from the upper part of glottis into the trachea for ventilation or maintenance of airway.
Infra-Glottic airway accessAccess to the airway by means of opening
the trachea below the glottis for ventilation or maintenance of airway.
2010KAN ISAC O
N
Non-invasive& Invasive
Invasive
![Page 4: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/4.jpg)
INFRA-GLOTTIC AIRWAY ACCESS
Broad classification:
2010KAN ISAC O
N
CricothyrotomyTracheostomy
Access to them by:
Percutaneously Surgically
![Page 5: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/5.jpg)
INFRA-GLOTTIC AIRWAY ACCESS
Done usually for:
2010KAN ISAC O
N
Emergency ICU patientssituations
CNV / CNIConditions when the airway access
becomes an emergency procedure
For airway access or maintenance of airway
![Page 6: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/6.jpg)
CNV / CNI
Could Not Ventilate / Could Not Intubate condition [airway can not be maintained by either mask ventilation or intubation] warrents emergency methods of alternative airway access.
Required inOTEmergency ward ICUother departments as an emergency 2010K
AN ISAC ON
![Page 7: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/7.jpg)
HISTORY
3000 years ago – India and Egypt
1300 years ago – Spanish person Vesalius
Upto 1970 – Chavelier Jackson advised against Percutaneous procedures.
After 1970 invent of Ciaglia dilatational techniques and Cooks dilational set, these were popularised.
Fiberoptic bronchoscopy - safety 2010KAN ISAC O
N
![Page 8: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/8.jpg)
TECHNIQUES
Percutaneous jet ventilation(through needle)
[and needle ventilation]
Retrograde intubation
Percutaneous cricothyrotomy
Percutaneous tracheostomy
Surgical cricothyrotomy
Surgical tracheostomy 2010KAN ISAC O
N
![Page 9: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/9.jpg)
ANATOMY
2010KAN ISAC O
N
![Page 10: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/10.jpg)
ANATOMY – LATERAL VIEW
2010KAN ISAC O
N
![Page 11: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/11.jpg)
VASCULAR ANATOMY
2010KAN ISAC O
N
![Page 12: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/12.jpg)
CRICOTHYROID MEMBRANE (CTM)
Between thyroid cartilage above and cricoid cartilage below.
1 cm in height and 2 cm in width.
Central part – thick and triangular shape with apex below. (Conus elasticus)
Does not calcify with age.
Upper part of membrane – vascular anastamosis.
2010KAN ISAC O
N
![Page 13: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/13.jpg)
TRACHEAL RINGS
Usual entry between 2nd and 3rd ring or 3rd and 4th ring.
Tracheal rings are cartilagenous in front and membraneous behind.
Space between the rings is 1-2 mm. (but expandable)
Thyroid gland comes in front. Innominate artery arches below.
2010KAN ISAC O
N
![Page 14: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/14.jpg)
ANAESTHESIA
IV sedationMidazolamFentanyl / other narcoticsPropofol
Topical 1% Lidocaine – Intratracheal
Nerve blocksSuperior Laryngeal nerveGlossopharyngeal nerve
2010KAN ISAC O
N
![Page 15: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/15.jpg)
PERCUTANEOUS JET VENTILATION
2010KAN ISAC O
N
![Page 16: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/16.jpg)
PERCUTANEOUS JET VENTILATION
Transtracheal Jet ventilation (TTJV) Used in
CNV / CNI situations Surgeries of upper airways Interim procedure till ET is placed
12 – 16 G needle High pressure O2 source [0.8 – 4 bar] O2 concentration 30 – 100 % I:E ratio = 1:1 Ventilation frequency = 150 cycles per
second Venturi principle involves
2010KAN ISAC O
N
![Page 17: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/17.jpg)
TTJV
2010KAN ISAC O
N
![Page 18: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/18.jpg)
TTJV
2010KAN ISAC O
N
![Page 19: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/19.jpg)
RETROGRADE INTUBATION
2010KAN ISAC O
N
![Page 20: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/20.jpg)
RETROGRADE INTUBATIONTranslaryngeal guided intubation Popularised by Waters in 1963.
2010KAN ISAC O
N
Indications: CNV / CNI condition upper airway trauma bleeding and secretions – unable to see glottis
Relative Contraindications: unfavourable anatomy (obesity, enlarged thyroid) laryngotracheal diseases coagulopathy infection
![Page 21: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/21.jpg)
RETROGRADE INTUBATION
2010KAN ISAC O
N
Procedure Through CTM epidural needle is pierced.
- ROUTINE TECHNIQUE
![Page 22: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/22.jpg)
RETROGRADE INTUBATION ROUTINE TECHNIQUE
2010KAN ISAC O
N
Epidural catheter is inserted into oral cavity. Catheter tip is taken out of mouth.
![Page 23: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/23.jpg)
RETROGRADE INTUBATION ROUTINE TECHNIQUE
2010KAN ISAC O
N ET tube railroaded and pulled into the trachea with the help of catheter.
![Page 24: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/24.jpg)
RETROGRADE INTUBATION ROUTINE TECHNIQUE
2010KAN ISAC O
N
Then the epidural catheter is removed from the oral end.
![Page 25: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/25.jpg)
RETROGRADE INTUBATION ROUTINE TECHNIQUE
2010KAN ISAC O
N Now the ET tube is kept in situ.
![Page 26: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/26.jpg)
RETROGRADE INTUBATION
2010KAN ISAC O
N
Here silk is threaded with the help of the epidural catheter.
- SILK PULL-THROUGH TECHNIQUE
![Page 27: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/27.jpg)
RETROGRADE INTUBATION SILK PULL-THROUGH TECHNIQUE
2010KAN ISAC O
N
Silk is tied at Murphy’s eye of ET tube
![Page 28: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/28.jpg)
RETROGRADE INTUBATION SILK PULL-THROUGH TECHNIQUE
2010KAN ISAC O
N
ET tube is placed into the trachea with the help of pulling of silk
![Page 29: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/29.jpg)
RETROGRADE INTUBATION SILK PULL-THROUGH TECHNIQUE
2010KAN ISAC O
N
Advantage: Reintubation is easy
![Page 30: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/30.jpg)
RETROGRADE INTUBATION
Complications: esophageal perforation hemoptysis hematoma edema laryngospasm infection, tracheitis tracheal fistula vocal cord damage subcutaneous emphysema 2010K
AN ISAC ON
![Page 31: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/31.jpg)
PERCUTANEOUS CRICOTHYROTO
MY
2010KAN ISAC O
N
![Page 32: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/32.jpg)
PERCUTANEOUS CRICOTHYROTOMY
Definition: Cricothyrotomy can be defined as a
technique for providing an opening in the space between the anterior inferior border of the thyroid cartilage and the anterior superior border of the cricoid cartilage for the purpose of gaining access to the airway.
Other names:s coniotomy, s cricothyroidotomy, s cricothyrostomy,s intercricothyrotomy, s minitracheostomy ands percutaneous dilatational tracheostomy.
2010KAN ISAC O
N
![Page 33: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/33.jpg)
PERCUTANEOUS CRICOTHYROTOMY
Indications: failed intubation head and neck trauma acute respiratory obstruction alternative to tracheostomy
It is done as an emergency procedure during transport of patients in the prehospital scenario in the emergency department in ICU in OT
2010KAN ISAC O
N
![Page 34: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/34.jpg)
PERCUTANEOUS CRICOTHYROTOMY
Relative Contraindications: intubated patients (> 3 days)
- subglottic stenosis
infants and children (< 10 years) - narrow airway
preexisting laryngeal disease
bleeding disorders
2010KAN ISAC O
N
![Page 35: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/35.jpg)
PERCUTANEOUS CRICOTHYROTOMY
Techniques Melker percutaneous dilational cricothyrotomy device
Pertrach percutaneous dilational cricothyrotomy device (guidewire and dilator are in a single unit)
Nutrake percutaneous dilational cricothyrotomy device
Portex and Melker Military (without guidewire) device
2010KAN ISAC O
N
[Used in emergenciesIn expert hands – 90 seconds (Ref: Benumof)]
![Page 36: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/36.jpg)
PERCUTANEOUS CRICOTHYROTOMY - TECHNIQUE
2010KAN ISAC O
N
entry through the CTM.
![Page 37: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/37.jpg)
PERCUTANEOUS CRICOTHYROTOMY - TECHNIQUE
2010KAN ISAC O
N
usually horizontal incision of skin.
![Page 38: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/38.jpg)
PERCUTANEOUS CRICOTHYROTOMY - TECHNIQUE
2010KAN ISAC O
N
entry by 14 Fr. introducer and 17 G needle.
the position is confirmed by air aspiration.
![Page 39: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/39.jpg)
PERCUTANEOUS CRICOTHYROTOMY - TECHNIQUE
2010KAN ISAC O
N
then guidewire is inserted into trachea.
![Page 40: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/40.jpg)
PERCUTANEOUS CRICOTHYROTOMY - TECHNIQUE
2010KAN ISAC O
N serial dilator or horn like single dilator or tracheostomy tube loaded dilator.
![Page 41: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/41.jpg)
PERCUTANEOUS CRICOTHYROTOMY - TECHNIQUE
2010KAN ISAC O
N
now the tracheostomy tube is kept in situ.
![Page 42: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/42.jpg)
PERCUTANEOUS CRICOTHYROTOMY
Complications Early:
asphyxia hemorrhage improper or unsuccessful tube placement subcutaneous emphysema pneumothorax esophageal / mediastinal perforation vocal cord injury
Late: tracheal / subglottic stenosis TE fistula infection tracheomalacia
2010KAN ISAC O
N
![Page 43: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/43.jpg)
PERCUTANEOUS TRACHEOSTOMY
2010KAN ISAC O
N
![Page 44: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/44.jpg)
PERCUTANEOUS TRACHEOSTOMY
Definition: Tracheostomy can be defined as a technique
for providing an opening in the space between any two tracheal rings (usually between 2nd and 3rd or 3rd and 4th rings) for the purpose of gaining access to the airway.
Except the entry point it is same like crico thyrotomy. Yet because of entry point there are some basic differences between two.
2010KAN ISAC O
N
![Page 45: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/45.jpg)
CRICOTHYROTOMY & TRACHEOSTOMYSl. No. Cricothyrotomy Tracheostomy
1. Used in emergencies Slightly more time consuming
2. As a temporary airway access Long term maintenance of airway
3. Fiberoptic view not necessary Recommended
4. LA / Sedation less required Adequate analgesia is needed
5. Done only in adults In adults and children
6. Less bleeding & complications
Needs more expertise
7. Ideal in obese patients, huge thyroid, innominate artery
Ideal for upper airway masses
8. Speed and simplicity For ICU patients
![Page 46: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/46.jpg)
PERCUTANEOUS TRACHEOSTOMY
Indications: usually done in ICU patients for
continuation of airway maintenanceweaning from ventilatorobstruction in airwaytracheal toileting
in childrenin emergency situationsalso in elective conditions (as Cricothyrotomy
is not given preference in children) 2010KAN ISAC O
N
![Page 47: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/47.jpg)
PERCUTANEOUS TRACHEOSTOMY
Relative Contraindications: midline neck mass (including thyroid) high innominate artery inability to palpate cricoid and trachea unprotected airway with PEEP > 20 cmH2O coagulopathy
[Now it is recommended to use fiberoptic bronchoscope to add safety to this procedure.]
2010KAN ISAC O
N
![Page 48: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/48.jpg)
PERCUTANEOUS TRACHEOSTOMY - TECHNIQUE
2010KAN ISAC O
N
after adequate analgesia incision of skin over trachea is made at the access site.
![Page 49: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/49.jpg)
PERCUTANEOUS TRACHEOSTOMY - TECHNIQUE
2010KAN ISAC O
N
needle position is confirmed by aspiration of air as well as fiberoptic viewing of trachea.
![Page 50: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/50.jpg)
PERCUTANEOUS TRACHEOSTOMY - TECHNIQUE
2010KAN ISAC O
N through 14 G needle a guidewire is inserted.
![Page 51: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/51.jpg)
PERCUTANEOUS TRACHEOSTOMY - TECHNIQUE
2010KAN ISAC O
N
through guidewire with a horn like gradational dilator, trachea is dilated upto the required size.
![Page 52: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/52.jpg)
PERCUTANEOUS TRACHEOSTOMY - TECHNIQUE
2010KAN ISAC O
N
then the tracheostomy tube is kept in situ.
![Page 53: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/53.jpg)
COOKS DILATOR SET (CIAGLIA TECHNIQUE)
2010KAN ISAC O
N
![Page 54: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/54.jpg)
PERCUTANEOUS TRACHEOSTOMY
http://www.youtube.com/watch?v=XkGHpzrEI0Y
![Page 55: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/55.jpg)
PERCUTANEOUS TRACHEOSTOMY
Complications Early:
hemorrhagesubcutaneous emphysemapneumothoraxrecurrent laryngeal nerve injury
Late: infectionTE fistulagranuloma laryngotracheal stenosis
2010KAN ISAC O
N
![Page 56: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/56.jpg)
SURGICAL INVASIVE AIRWAYS
2010KAN ISAC O
N
![Page 57: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/57.jpg)
SURGICAL CRICOTHYROTOMY Open Cricothyrotomy:
instead of piercing of needle, incision is made and tracheostomy tube is inserted.
Advantages:rapid procedure – in emergenciesspecial instrumentations not required
Disadvantages:Surgeon’s jobOT required – cost factorbleeding 2010K
AN ISAC ON
![Page 58: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/58.jpg)
SURGICAL CRICOTHYROTOMY
Indications:trauma patients – to secure airway fasterairway obstruction due to
trauma FB stenosis mass
Relative Contraindications: in children laryngeal fracture
2010KAN ISAC O
N
![Page 59: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/59.jpg)
SURGICAL TRACHEOSTOMY
FasterSafer
Definite
The limitations are:it needs a surgeon to perform,it requires an operating room (becomes expensive)
it requires an anesthesiologist to be with the patient
}
2010KAN ISAC O
N
Gold standard
![Page 60: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/60.jpg)
TAKE HOME MESSAGE
Infra-glottic invasive airway access techniques are easy to perform – only need is mindset
Cricothyrotomy for emergencies Tracheostomy for ICU patients and
paediatric patients.Our goal is to be a safe
anaesthesiologist. To be safe at times you have to be bold.
2010KAN ISAC O
N
![Page 61: I NFRA - GLOTTIC INVASIVE AIRWAYS Dr. S.A.Rajkumar, Intensivist, Tirunelveli](https://reader035.vdocuments.us/reader035/viewer/2022062417/5517e3f8550346c1568b463c/html5/thumbnails/61.jpg)
THANK YOU