• Dennis Christoph Harrer, Patricia Mester, Clara-Larissa Lang, Tanja Elger, Tobias Seefeldt, Lorenz Wächter, Judith Dönz, Nina Doblinger, Muriel Huss, Georgios Athanasoulas, Lea U Krauß, Johannes Heymer, Wolfgang Herr, Tobias Schilling, Stephan Schmid, Martina Müller, and Vlad Pavel.
• Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany.
• J Clin Anesth. 2024 Sep 21; 99: 111631111631.

BackgroundDetailed reports are scarce on minimally-invasive tracheostomy (MIT) techniques for critically ill patients with challenging anatomy or complex coagulopathies. In such high-risk patients, conventional percutaneous dilatational tracheostomy (PDT) may lead to severe complications.MethodsAiming to broaden the scope of MIT for patients previously excluded due to high risks, we developed a new care bundle (MIT technique), specifically designed for intensive care specialists. Our study examined the outcomes of MIT in 32 high-risk patients treated in an ICU of a University Hospital with specific focus on gastrointestinal and liver diseases.ResultsWe have modified the conventional PDT technique by incorporating an initial skin incision, blunt dissection, diaphanoscopy-guided probe puncture, and continuous bronchoscopic monitoring. Our care bundle also introduces an anterolateral approach for tracheal entry, a significant advancement for patients with complex neck anatomy or dense vasculature, where an anterolateral trajectory avoids midline blood vessels. This enhanced method has proven to be safer than traditional PDT, with a notable absence of post-procedural hemorrhages, cannula misplacements, or infections.ConclusionThe use of our refined care bundle enabled swift minimally-invasive tracheostomy in high-risk patients without the occurrence of serious complications.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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