Background
Published clinical data on minimally invasive tracheostomy (MIT) techniques in critically ill patients with prior neck surgery—particularly in the context of retracheostomy following surgical tracheostomy—remain limited. Generally, conventional percutaneous dilatational tracheostomy has not been recommended for such high-risk patients, owing to the potential for critical complications.
Methods
This study presents data on MIT performed in 11 high-risk patients with previous neck surgery treated in a university hospital intensive care unit (ICU) specializing in hepatic and gastrointestinal diseases. Of note, all procedures were performed directly at the patient's bedside.
Results
Eleven critically ill patients (age 56-75 years; 8 males and 3 females) with a previous history of neck surgery, including surgical tracheostomy (n = 7), neck dissection (n = 2), pharyngectomy (n = 1), and thymectomy (n = 1), underwent (re)tracheostomy to enable prolonged ventilation for inappropriate arousal or delayed weaning. Tracheostomy was performed exclusively via the MIT approach, the mainstay tracheostomy technique in our ICU. Specific risk factors for tracheostomy involved obesity (morbid obesity in 2 patients, with a body mass index of 43.0 and 71.0), cutaneous and tracheal scarring (n = 5), dense pretracheal vasculature (n = 3), postradiotherapy skin fibrosis (n = 1) and the presence of goiters (n = 2). In all patients, MIT was performed without complications, showcasing the safety of the MIT approach even in cervically preoperated high-risk patients.
Conclusions
MIT could be used as a nonsurgical tracheostomy in ICUs in a wide spectrum of patients, including high-risk patients previously deemed ineligible for nonsurgical tracheostomy.