The use of the "Airtraq Laryngoscope" for securing proper positioning of an endotracheal tube during bedside percutaneous dilatational tracheostomy

Percutaneous dilatational tracheostomy (PDT) is a widely used and accepted method for long-term ventilation of critically ill patients in many intensive care units (ICUs). However, serious complications related to PDT have been reported, including several cases of intraoperative loss of airway with fatal consequences. (1) Generally, this is the result of the required delicate position of the endotracheal tube (ETT) during PDT, with a partially deflated cuff located at the level of the vocal cords. This position of the ETT may lead to accidental extubation and loss of airway during the procedure, especially in difficult patients with a short, bull neck. On the other hand, too deep a position of the tip of the ETT can lead to accidental punction of Murphy's eye, with impalement of the ETT. (2) Unfortunately, the operator performing the PDT evaluates the correct position of the tip of the ETT on the basis of questionable, indicative, indirect parameters and clinical signs such as: capnography, the curve on the ventilator monitor and respiratory movements of the thoracic wall.