Using a laryngeal mask airway during percutaneous dilatational tracheostomy is safe and obviates the need for paralytics

Rajiv Sonti, Michael Sanley, Ajeet Vinayak

Research output: Contribution to journalArticle


Background:Bedside percutaneous tracheostomy (PT) placement in critically ill patients is performed in a variety of ways largely driven by institutional preference. We have recently transitioned to primarily extubating the patient and placing a laryngeal mask airway (LMA) before tracheostomy insertion in lieu of retracting the endotracheal tube (ETT) in place. This allows for lower sedative use and provides a superior view of the operative field. Here we seek to describe the safety and efficiency of that approach.Methods:This is a single-center cross-sectional study from 2014 to 2016 comparing patients who underwent PT with the ETT in place retracted to the proximal larynx versus those who were extubated and had a LMA placed. Procedural length sedative totals and safety outcomes were recorded.Results:In total 125 patients underwent PT during the study period 75 via a LMA and 50 via existing ETT. There was no difference in procedural duration (LMA: 53.5±21.4 min vs. ETT: 50.4±16.8; P=0.41) total complications (LMA: 29.3% vs. 16%; P=0.09) or major complications (4% in both groups). Cisatracurium use was significantly lower in the LMA arm (LMA: 1.0±3.6 mg vs. ETT: 11.5±5.9 mg; P<0.01).Conclusion:Replacing the ETT with an LMA before PT is equally safe does not increase total procedural duration and all but eliminates the need for paralytic agents.

Original languageEnglish (US)
Pages (from-to)179-183
Number of pages5
JournalJournal of Bronchology and Interventional Pulmonology
Issue number3
StatePublished - Jul 1 2019
Externally publishedYes


All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine

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