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Critical Care Research and Practice
Volume 2010 (2010), Article ID 397270, 4 pages
http://dx.doi.org/10.1155/2010/397270
Clinical Study

Retrosternal Percutaneous Tracheostomy: An Approach for Predictably Impossible Classic Tracheostomy

1Department of Cardiothoracic Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel
2Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel
3Post-Anesthesia Care Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel
4Department of Anesthesia, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel
5Surgical Intensive Care Unit and Department of Surgery “B”, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel

Received 19 August 2009; Accepted 16 December 2009

Academic Editor: Stephen M. Cohn

Copyright © 2010 Philippe Biderman et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Percutaneous tracheostomy is a routine procedure in intensive care units. In cases of very low position of the larynx, cervical spine deformation, morbid obesity, or neck tumor, performance of the classic tracheostomy is inapplicable. Retrosternal approach to tracheostomy in such 20 patients is herein reported. After preoperative neck computerized tomography to define the neck anatomy, a small suprasternal incision followed by a short retrosternal tissue dissection to expose the trachea was done; the trachea was then catheterized at the level of the 2nd ring in the usual tracheostomy manner. The immediate and late ( 6 months) outcomes were similar to that of the standard tracheostomy. Thus, percutaneous retrosternal tracheostomy is safe in patients with abnormal positioning of the trachea or neck constitution. It is a bedside applicable technique, that, however, requires caution to avoid hazardous vascular complications.