Increasing the precision of simulated percutaneous dilatational tracheostomy—a pilot prototype device development study
Athia Haron,
Lutong Li,
Eryl A. Davies,
Peter D.G. Alexander,
Brendan A. McGrath,
Glen Cooper,
Andrew Weightman
Affiliations
Athia Haron
School of Engineering, Faculty of Science and Engineering, The University of Manchester, Manchester, UK; Corresponding author
Lutong Li
School of Engineering, Faculty of Science and Engineering, The University of Manchester, Manchester, UK
Eryl A. Davies
Greenlane Department of Cardiothoracic and ORL Anaesthesia, Auckland City Hospital, Auckland, New Zealand
Peter D.G. Alexander
Manchester University NHS Foundation Trust, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
Brendan A. McGrath
Manchester University NHS Foundation Trust, Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
Glen Cooper
School of Engineering, Faculty of Science and Engineering, The University of Manchester, Manchester, UK
Andrew Weightman
School of Engineering, Faculty of Science and Engineering, The University of Manchester, Manchester, UK
Summary: Percutaneous dilatational tracheostomy (PDT) is a bedside medical procedure which sites a new tracheostomy tube in the front of the neck. The critical first step is accurate placement of a needle through the neck tissues into the trachea. Misplacement occurs in around 5% of insertions, causing morbidity, mortality, and delays to recovery. We aimed to develop and evaluate a prototype medical device to improve precision of initial PDT-needle insertion. The Guidance for Tracheostomy (GiFT) system communicates the relative locations of intra-tracheal target sensor and PDT-needle sensor to the operator. In simulated “difficult neck” models, GiFT significantly improved accuracy (mean difference 10.0 mm, ANOVA p < 0.001) with ten untrained laboratory-based participants and ten experienced medical participants. GiFT resulted in slower time-to-target (mean difference 56.1 s, p < 0.001) than unguided attempts, considered clinically insignificant. Our proof-of-concept study highlights GiFT’s potential to significantly improve PDT accuracy, reduce procedural complications and offer bedside PDT to more patients.
