Percutaneous Dilation Tracheostomy - When to opt for it?
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Case :
An 83-year-old patient mechanically ventilated by endotracheal tube was admitted in our general ICU because of acute respiratory failure due to chronic bronchitis. He had undergone a previous lung resection for tuberculosis 40 years ago. He had advanced pulmonary emphysema and prominent barrel chest. Mycotic pneumonia was diagnosed. Due to weaning failure and persistent dependency on MV, the patient was scheduled for video-assisted TS. Surgical TS and translaryngeal TS (TLT) were excluded because neck palpation revealed cricoid prominence at jugular notch level, so the first tracheal ring was in a retro-sternal position. For this video bronchoscopy failed to provide transillumination. Percutwist TS was excluded because of the short, rigid dilator (4 cm). Ciaglia Blu-Rhino™ TS set (CBR) was chosen along with total intravenous anesthesia (TIVA).....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4050938/
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