The use of a laryngeal mask airway during percutaneous tracheostomy

TLDR

Bedside percutaneous tracheostomy (PCT) is increasingly used in ICUs, and recent reports describe the use of a laryngeal mask airway (LMA) to facilitate the procedure. We present a series of 18 patients in whom an LMA was inserted prior to PCT. In 18 patients, LMA‑assisted PCT succeeded in 17 cases; the single failure was due to oxygen desaturation from a likely oedematous larynx, while major bleeding occurred in two patients (one transfusion) and minor bleeding in two, with no other LMA‑related complications, indicating that LMA use during PCT is a viable, low‑complication technique.

Abstract

SummaryBedside percutaneous tracheostomy (PCT) for patients in intensive care units (ICU) is gaining popularity. Recently, the use of a laryngeal mask airway (LMA) to facilitate PCT has been described. We present a series of 18 patients where an LMA was inserted prior to PCT. This was successful in all but one patient. PCT could not be performed in this patient as oxygen desaturation had developed after inserting the LMA. The reason for this was probably an oedematous larynx, secondary to long-term intubation. Major bleeding in two patients [one of whom required packed red blood cell (RBC) transfusion] required surgical intervention and two patients had minor bleeding. No complications were related to the insertion or presence of the LMA during PCT, with the exception of the one patient cited above. The use of an LMA during PCT is a method of treatment worth noting in ICU patients. This technique may provide suitable conditions for performing PCT and is free from the complications associated with the presence of an endotracheal tube.