A simple technique: External light guidance for percutaneous dilatational tracheotomy

Objective: Percutaneous dilatational tracheotomy (PDT) is a commonly used technique considered as safe as open tracheotomy, however there is still room for improvement. Bronchoscopic visualization aids safe performance of the procedure, however exact needle placement is still not optimal. We present our experience with a simple modification of the PDT technique using an external white light guide (ELG) to facilitate identification of the needle entrance point. Methods: Retrospective case series of 15 consecutive patients undergoing ELG PDT. ELG is performed by placing a white light source to the anterior trachea wall externally and identifying the transmitted light inside the trachea with a bronchoscopic to predict the exact needle entrance point. Results: The transmitted light was rapidly identified in all 15 patients, and the endotracheal tube tip withdrawn to appropriate position in the subglottis in approximately 10 seconds in 13/15 patients. The needle enters within 1-2mm of the visible light spot. Discussion: External light guidance is a simple modification of PDT that facilitates rapid placement of endotracheal tube in the subglottis, aids needle placement in the anterior wall and reduces surgeon anxiety.