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

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.