Q: Describe one technique during percutaneous tracheostomy to decrease the incidence of respiratory acidosis due to a delay in mechanical ventilation?
Answer: Bridge with pediatric ETT
In high-risk patients with little reserve or with relatively high ventilator settings, respiratory acidosis may occur during percutaneous tracheostomy. This is due to a delay between discontinuation from mechanical ventilator and insertion of a tracheostomy tube. This complication can be monitored by the use of end-tidal carbon dioxide (ET-CO2). This complication can be avoided by the ETT exchange with pediatric endotracheal tube (ETT) before initiating the procedure. Pedatric ETT can stay in trachea till the tracheostomy is finished and confirmed.
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Reference:
Ferraro F, Capasso A, Troise E, et al. Assessment of ventilation during the performance of elective endoscopic-guided percutaneous tracheostomy: clinical evaluation of a new method. Chest 2004; 126:159.
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