Insert (B) depicts how the guidewire, passing
through the tip of the threaded dilator, prevents the threads from “”catching”" other structures. Figure 5 The self-retaining retractor. Insert (A) depicts how the self-retaining AZD9668 in vitro retractor is passed over the guidewire in locked position. Picture (B) shows how the retractor enables hands free lateral retraction of the pre-tracheal soft tissue, and the aperture on the anterior tracheal wall. The limiter ridge prevents insertion of the retractor too far into the trachea. Figure 6 The spherical tip flexible introducer. Insert (A) depicts the elastic property of the introducer constructed with a circular helical spring. Picture (B) shows the flexible introducer positioned in the trachea facilitated by the self-retaining retractor. Figure 7 Insertion of the tracheostomy tube in the trachea. Picture shows the insertion of the tracheostomy tube in the trachea over the spherical tip flexible introducer. Arrow depicts the guidewire inside the introducer. Results During the study period, 100 patients underwent percutaneous tracheostomy by the modified technique described in this study. All percutaneous tracheostomies were performed on intubated patients at the bedside. Ninety patients (90%) underwent Regorafenib datasheet the procedure in the ICU. The remaining 10 patients were in another hospital location: 4 patients were in the hospital step-down unit, 3 in the trauma room, and 3
in the post-anesthesia recovery room. Demographic data showed that the majority of the patients were men (68%) with a mean age of 49 ± 2.2 years. The mean
BMI of the patients was 25.6 ± 2.1, and the thyromental distance was 6.2 ± 0.3 cm. The pretracheal tissue thickness was 1.5 ± 0.7 cm. Twenty five percent of the percutaneous tracheostomies were performed on trauma patients, and18% on acute care surgery non-trauma patients. The remaining patients were admitted to the hospital because of 3-mercaptopyruvate sulfurtransferase clinical (29%) or neurologic (28%) related diseases. The most common indication for percutaneous tracheostomy (95 patients) was the need for prolonged ventilatory support, with a mean intubation period of 9.5 ± 4.2 days. Five patients underwent the procedure because of severe maxillofacial trauma. Percutaneous tracheostomy procedure time was 5.1 ± 0.3 minutes, assessed from the time of skin incision to the time of placement of the tracheostomy tube inside the airway. A tracheostomy tube size 9.0 mm (internal diameter) was used in 70 patients (70%), a size 8.5 mm (internal diameter) was used in 20 patients, and a tube size 8.0 mm in the remaining patients. The mean prothrombin time prior to the procedure was 80.9 ± 5.5% (Quick Value), the activated partial thromboplastin time was 30.6 ± 1.9 seconds, the mean INR was 1.2 ± 0.1, and platelet count was 216.3 ± 35.5 x103/uL. Patients were followed for an average of 6.6 ± 2.2 days for complications.