ABSTRACT

Background:

Tracheostomy is preferred in patients with extended mechanical ventilation in order to prevent endotracheal tube related problems in intensive care units. Percutaneous dilatational tracheostomy is the most preferred method. Lighted stylet is found in many facilities and used in difficult intubation. In this study we aimed to investigate effectiveness of lighted stylet on improving success rates of percutaneous dilatational tracheostomy.

Methods:

The study was retrospective and the patient files were scanned backwards. We included 20 patients admitted in intensive care unit. Lighted stylet was advanced in the endotracheal tube, 1 cm distal end of the stylet was kept out from endotracheal tube. Endotracheal tube was drawn back until second cartilage level. This level was chosen because that point is the optimum site for seeing the transillumination of light on anterior neck wall. After marking, needle was inserted in this point and advanced into the trachea lumen. Guide wire was advanced over the needle then the needle was removed. Position of guide wire at midline, distance between guide wire and vocal cords, any damage to posterior tracheal wall, cartilage tissue and vascular structures were evaluated with Fiber-optic bronchoscope.

Results:

All procedures were successfully performed. Temporary peripheral oxygen desaturation and bradycardia were noted in only one patient during use of lighted stylet in percutaneous dilatational tracheostomy. Mean duration of interventions were 20.2 ± 4.1 minutes. In terms of complication, endotracheal tube cuff balloon puncture was noted in only 3 patient.

Conclusion:

Lighted stylet -that can be easily found in many facilities- can be simply used in identification of proper localization in Griggs method for percutaneous dilatational tracheostomy. Lighted stylet may decrease complication rates and increase procedural safety.