• Walied Abdulla, Ute Netter, Susanne Abdulla, and Igor Isaak.
• Department of Anaesthesiology and Intensive Care Medicine, Klinikum Bernburg. Teaching Hospital, Martin Luther University Halle-Wittenberg, Germany. wailed.abdulla@t-online.de
• Middle East J Anaesthesiol. 2008 Feb 1;19(4):803-18.

AbstractIn a prospective observational study we compared the results of 297 elective tracheostomies under jet-ventilation with regard to its complication rate and practicability. Of those, 156 patients underwent surgically created tracheostomy (SCT) and 141 patients percutaneous dilational tracheostomy (PDT). Initially, in 159 patients jet-ventilation was performed using a jet-cannula inserted intratracheally through the cricothyroid membrane. In the remaining 138 patients the jet-ventilator was connected to the endoscopic instrument channel (2.2 mm ID, 4.9 mm OD, 600 mm Length) and ventilation via the fiberoptic bronchoscope (FB-15x, Pentax Europe GmbH, Hamburg) was applied manually. With jet-ventilation, oxygenation was maintained throughout the procedure as long as the tracheal puncture was successful und jet-cannula fixed in place. The bronchoscope-guided gas stream, when compared to jet-cannula inserted intratracheally, offered more space for tracheostomy and safety for the patient. The permanent danger of mishappenings and dislocation involved with the jet-cannula could be avoided, since the bronchoscope was operating on under direct visualization. Under these circumstances, PDT is an acceptable approach to inserting a tracheostomy tube under jet-ventilation via bronchoscope, particularly for the management of difficult airway in critically ill patients.

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