Materials and methods
death, ®, laryngo-tracheal disease, fracture, tracheal cartilage damage, non-traumatic, Cancer
DILATION, DILATION, SKIN, CANCER
Our cadaver study was performed at the 1st Department of Pathology and Experimental Cancer Research of Semmelweis University with permission of Semmelweis University Regional and Institutional Committee of Science and Research Ethics (117-1/2006 SE-RKEB; 2014.03.17). Data were collected anonymized. Data analysis and statistical plan was written and filed with a private entity before data were accessed.The simple-blinded observational method was carried out by two experts in the field of surgical and percutaneous tracheostomies—by an intensive care specialist and an ENT surgeon with additional specialization of intensive care medicine—both for more than 5 years at a University hospital. The first expert had performed the procedures and the second one had checked the results, respectively.Cadavers (who were not intubated before death) were collected; autopsies as well as preparation of the airway complexes from the cadavers following tracheostomy were carried out by mortuary technician. Site of tracheal cannula insertion, estimation of tracheal cartilage damage were scored by the non-operator expert without the knowledge of the insertion technique.Insertion site was scored as 1: cricoid-1st tracheal ring space; 2: 1st-2nd tracheal ring space; 3: 2nd-3rd tracheal ring space. Estimation of ring injuries was classified as: 1: none; 2: one ring fractured; 3: two or more rings fractured.Data about the cadavers [e.g., date and time of death (72 h or more before intervention), age, gender] as well as the lack of exclusion criteria (e.g., previous laryngo-tracheal disease, injury, previous tracheostomy, visible or palpable damage on the neck) were collected and recorded on individual sheets with registration numbers.Randomization was carried out by a 6-sided dice: Nr 1-2, 3-4 and 5-6 were linked with traditional Griggs (Cadavers were positioned in standard hyperextended position for tracheostomy, and the exact method was performed according to the randomization. Details of the procedures are briefly presented below [13] and were discussed previously elsewhere. [14] Percutaneous tracheostomy kits available from the market were used. For traditional and modified Griggs’ technique Portex® GRIGGS© Percutaneous Dilation Tracheostomy Kit with Blue Line Ultra® tubes in different sizes were used according to the needs. For Ciaglia method Portex® ULTRAperc© Single Stage Dilator Technique Kit with Blue Line Ultra® tubes were applied in the same manner.Skin incisions were performed at the midpoint of cricoid cartilage and jugulum. Traditional Griggs’ technique:, no surgical preparation, direct tracheal puncture and unidirectional (transverse) tracheal dilation were performed followed by the insertion of tracheostomy cannula (Modified Griggs’ technique: a maximum 50 mm-wide skin incision, surgical pretracheal tissue preparation, and careful, visualized bidirectional (transverse and longitudinal) intercartilaginous forceps dilation of tracheal wall were performed (The Ciaglia Blue Rhino single dilator method was performed as reviewed by SP Ambesh (Upper airway complex was anatomized by a mortuary technician with maximal care for non-traumatic extraction. Site of insertion and posterior tracheal wall were inspected and recorded by the non-operator expert, then dissection of the posterior wall was carried out. Exact cannula position was checked and ring fracture inspected and palpated to avoid any “hidden” fracture covered by mucosa. The process was completed by photo documentation.