Translaryngeale tracheostomie bei Morbus Bechterew und Guillain-Barre- syndrom

Recently, the Translaryngeal Tracheostomy (TLT) has been developed by Fantoni [1,2]. This new technique has been suggested for long-term ventilated intensive care patients as an alternative to other minimal invasive tracheostomy techniques like the Percutaneous Dilatational Tracheostomy described by Ciaglia [3] or Griggs [4]. In comparison to these techniques, the main advantage of the TLT seems to be the access to the airway from inside the trachea to outside. This procedure minimizes the risk of luxations of parts of the tracheal wall into the tracheal lumen resulting in obstructive ventilatory problems. The often discussed risk of stomal infections associated with this technique due to a possible bacterial contamination of the mouth seems not to be clinically relevant. In the past minimal invasive tracheostomy techniques have only been recommended for patients with normal anatomical conditions and without any special risk factors. The present case report describes the successfull performance of a TLT in a patient with a severe M. Bechterew and respiratory failure due to a Guillain-Barre-syndrome. This patient was at high risk for operative complications during a conventional surgical tracheostomy due to his underlying diseases.