CHEST Guidelines-Assessment-of-Ventilation-During-the-Performance-o

Assessment-of-Ventilation-During-the-Performance-o

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In a recent issue of <em>CHEST</em>, a study by Vargas et al. discussed the use of a double-lumen endotracheal tube (DLET) during percutaneous dilatational tracheostomy procedures. In response, Dr. Ferraro and colleagues critiqued this approach, arguing it cannot be used with the Fantoni translaryngeal tracheostomy technique and cautioned against DLET’s purported advantages. They highlighted potential limitations of the DLET, such as life-threatening complications from endotracheal tubes (ETTs) and difficulties in endoscopic vision during procedures, particularly for patients with infantile glottis. They pointed out discrepancies in the study findings, questioning the sample size and results, noting that while the study showed no complications in the ETT group, there were issues in 10% of the DLET cases. Ferraro et al. advocated for their continuous ventilation technique, which provides broader endoscopic vision and reduces complications, as more effective, and safer than Vargas et al.'s approach.

Responding to the critique, Dr. Vargas and colleagues defended their methodology. They addressed the criticism that the DLET design is currently unsuitable for Fantoni TLT but suggested future design improvements could rectify this. The primary goal of their study was to test the feasibility of PDT using DLET, successfully completed in all patients without switching to a conventional tube, indicating the study’s sufficient power and statistical validity. They refuted claims of compromised endoscopic vision and ventilation, emphasizing that DLET provides clear views from the vocal cords to the carina. They suggested that the findings necessitate further research to refine DLET applications in PDT, asserting that DLET remains a valuable tool for stable ventilation and airway protection during the procedure.

Keywords

double-lumen endotracheal tube

percutaneous dilatational tracheostomy

Fantoni translaryngeal tracheostomy

endoscopic vision

infantile glottis

continuous ventilation technique

complications

sample size

airway protection

stable ventilation