Grand Rounds Cricothyroidotomy: When, Why, and Why Not?
نویسنده
چکیده
A 25-year-old, otherwise healthy, active duty Navy male patient was referred from a ship with persistent pneumonia despite intravenous antibiotics administered by the ship's medical officer. He was admitted to the intensive care unit, rapidly developed adult respiratory distress syndrome (ARDS), and required airway support. However, the anesthesiologist on call was unable to successfully translaryngeally intubate the patient; as the patient's oxygen saturation began to drop rapidly, it was clear that a surgical airway was going to be necessary. The senior surgical resident performed a cricothyroidotomy, placed a #6 cuffed endotracheal tube through the incision, and ventilated the patient, who responded well with rapid return of good oxygen saturation. When things had settled down, the senior resident turned to me and asked what I, the otolaryngologist-to-be, thought we should do next. I realized I really did not know a good answer to his question, but my impression was that otolaryngologists rarely perform cricothyroidotomies because we are able to perform an emergency tracheotomy in about the same time. I also thought that the risk of subglottic stenosis was our reason for being so reluctant to perform cricothyroidotomy, but I was not certain where I had learned this "dogma." That is why I chose this topic to review and discuss with you. I will first review the history of cricothyroidotomy and the surgical technique. Next, I will discuss the indications and contraindications and then compare the complications of cricothyroidotomy with tracheotomy. Most importantly, I will
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