Research Article
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Year 2021, , 232 - 237, 31.08.2021

Mustafa Özgür Cırık , Güler Eraslan Doğanay

https://doi.org/10.20492/aeahtd.835948

Abstract

ABSTRACT
Aim
Percutaneous Dilatational Tracheostomy (PDT) is a bedside procedure that can be performed in intensive care units in patients who need a long-term mechanical ventilator and require airway for various reasons. Performing the procedure with fiber optic bronchoscopy (FOB) provides convenience and reduces complications.
In this study, we aimed to evaluate the effectiveness and complications of PDTs opened with FOB in intensive care.
Material and Metod
With the approval numbered 05.03.2020 / 665, 110 patients who underwent PDT with FOB and Griggs method in Intensive Care Unit between the date 1st January 2018 and 7 th July 2020 were retrospectively evaluated. The demographic data, diagnoses, comorbidities, duration of mechanical ventilation, complications, prognosis, 28 and 90-day mortality were recorded retrospectively.
Results
96 patients were included in the study. Average age was 70.54. 58 of the patients were underwent PDT due to chronic obstructive pulmonary disease (COPD), 16 due to lung malignancy, 22 due to neurological diseases. 43 of the patients were transferred to the palliative service with home mechanical ventilation, 13 of them were referred to an external palliative center.Average procedure times were 12 min. in the neurological group, 13 min. in the COPD group, 14 min. in the malignant group.Our complication rate was 17.7%. 28-day mortality was lower in the neurological group to the malignant group; and was lower in the malignant group to the COPD group.
Conclusion
We think that the use of FOB should become widespread since the procedure is shorter and the complications are less in PDTs opened with FOB.

References

  • 1-Weisler MC, Couch ME. Trakeotomi ve entübasyon. In: Bailey BJ, Johnson JT, Newlands SD editors. Head & Neck Surgery – Otolaryngology. 4th ed. Ankara: Lippincott Williams & Wilkins; 2011;p 785-801.
  • 2-Jackson C. Tracheostomy. Laryngoscope 1909; 19: 285-90.
  • 3-Simpson TP, Day CJE, Jewkes CF, et al. The impact of percutaneous tracheostomy on intensive care unit practice and training. Anaesthesia. 1999;54:186–189.
  • 4-Naqvi SMA, Bashir MJ, Hussain M,et al. Percutaneous dilatational tracheostomy: A prospective analysis about the safety of procedure among ICU patients. Journal of Postgraduate Medical Institute (Peshawar – Pakistan) 2017;31(1):56–60.
  • 5-Batuwitage B, Webber S, Glossop A. Percutaneous tracheostomy. Continuing Education in Anaesthesia Critical Care & Pain. 2014;14(6):268–272.
  • 6-Yıldırım F ,Güllü YT, Demirel CB. Yoğun Bakımda Perkütan Trakeostomi. Eurasian J Pulmonol 2015.
  • 7-Friedman Y, Fildes J, Mizock B, et al. Comparison of percutaneous and surgical tracheostomies. Chest 1996;110:480-485.
  • 8-Anon JM, Gomez V, Escuela MP, et al. Percutaneous tracheostomy:Comparison of Ciaglia and Griggs techniques. Crit Care 2000;4:124-128.
  • 9-Pietkiewicz P, Machata W, Kusmierczyk K, et al. Early complications of Griggs percutaneous tracheostomy in own material. Otolarryngol Pol 2012;66:196-200.
  • 10-Gupta P, Modrykamien A. Fatal case of tension pneumothorax and subcutaneous emphysema after open surgical tracheostomy. J Intensive Care Med. 2014;29:298–301.
  • 11-Ahuja H, Mathai AS, Chander R, et al. Case of difficult tracheostomy tube insertion: A novel yet simple solution to the dilemma. Anesth Essays Res. 2013;7:402–404.
  • 12-Deganello A, Sofra MC, Facciolo F, et al. Tracheotomy-related posterior tracheal wall rupture, trans-tracheal repair. Acta Otorhinolaryngol Ital. 2007;27:258–262.
  • 13-Fikkers BG, van Veen JA, Kooloos JG,et al. Emphysema and pneumothorax after percutaneous tracheostomy: Case reports and an anatomic study. Chest. 2004;125:1805–1814.
  • 14-Duann CW, Hsieh MS, Chen PT,et al. Successful percutaneous tracheostomy via puncture through the thyroid isthmus. Respirol Case Rep. 2014;2:57–60.
  • 15-Cipriano A, Mao ML, Hon HH, et al. An overview of complications associated with open and percutaneous tracheostomy procedures. Int J Crit Illn Inj Sci 2015;5:179-188.
  • 16-Simon M, Metschke M, Braune SA, et al. Death after percutaneous dilatational tracheostomy: a systematic review and analysis of risk factors. Critical Care 2013;17:R258.
  • 17-Levent E, Sarıman N. Pnömotoraks olmaksızın pnömomediastinum ve derialtı amfizemi gelişen bronş astması olgusu. Solunum 2008; 10:131- 135.
  • 18-Karmy-Jones R, Nathens AB, Stern E. Springer Science and Business Media. Thoracic trauma and critical care. 1st ed 2012.
  • 19-Öncül S, Yılmaz M, Gaygusuz E, et al. Our experience in percutaneous tracheostomy which performed by Griggs method: 38 cases. Medical Journal of Kocaeli 2014; 2:1-4.
  • 20-Barba CA, Angood PB, Kauder DR, et al. Bronchoscopic guidance makes percutaneous tracheostomy a safe, cost-effective, and easy-to-teach procedure. Surgery 1995;118:879-883.
  • 21-Maddali MM, Pratap M, Fahr J, et al. Percutaneous tracheostomy by guidewire dilating forceps technique: review of 98 patients. J Postgrad Med 2001;47:100-103.
  • 22-Gobatto AL, Besen BA, Tierno PF. Ultrasound-guided percutaneous dilational tracheostomy versus bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients (TRACHUS): a randomized noninferiority controlled trial. Intensive Care Med 2016;42:342.

Yoğun Bakım Ünitesinde Fiberoptik Bronkoskopi Eşliğinde Uygulanan Perkütan Trakeostomilerin Retrospektif Değerlendirilmesi

Year 2021, , 232 - 237, 31.08.2021

Mustafa Özgür Cırık , Güler Eraslan Doğanay

https://doi.org/10.20492/aeahtd.835948

Abstract

ÖZET(TR)
Amaç
Perkütan Dilatasyonel Trakeostomi (PDT) yoğun bakım ünitelerinde uzun süreli mekanik ventilatör ihtiyacı bulunan ve çeşitli sebeplerle hava yolu gerektiren hastalarda yatak başı uygulanabilen bir işlemdir.İşlemin fiber optik bronkoskopi (FOB) ile yapılması kolaylık sağlar ve komplikasyonları azaltır.
Bu çalışmada yoğun bakımda FOB eşliğinde açılan PDT’lerin etkinliğini ve komplikasyonları değerlendirmeyi amaçladık.
Gereç ve Yöntem
05.03.2020/665 sayılı onay alınarak hastanemiz Anestezi Yoğun Bakım Ünitesi’nde 01 Ocak 2018-07 Temmuz 2020 tarihleri arasında FOB eşliğinde Griggs yöntemi ile PDT açılan 110 hasta retrospektif olarak değerlendirildi.Hastaların demografik verileri, tanıları, comorbiditeleri, mekanik ventilasyon süreleri, gelişen komplikasyonlar, prognozları, 28 ve 90 günlük mortaliteleri retrospektif olarak kaydedildi.
Bulgular
Çalışmaya 96 hasta dahil edildi. Yaş ortalaması 70,54 idi. Hastaların 58’i kronik obstrüktif akciğer hastalığı (KOAH) ,16 tanesi akciğer malignitesi, 22’si nörolojik hastalıklar nedeniyle PDT açılan hastalardı.Hastalardan 43 tanesi ev tipi mekanik ventilatöre geçilip palyatif servise nakledilmiş, 13 tanesi ev tipine geçilmeden dış palyatif merkeze sevk edilmiştir. Ortalama işlem süreleri nörolojik grupta 12dk, KOAH grubunda 13dk, malign grupta 14dk idi. Komplikasyon oranımız %17.7 idi.28 günlük mortalite nörolojik hasta grubunda malign hasta grubuna göre; malign hasta grubunda KOAH hasta grubuna göre daha düşüktü.
Sonuç
FOB eşliğinde açılan PDT’lerde işlem daha kısa süreli ve komplikasyonlar daha az olduğundan FOB kullanımının yaygınlaşması gerektiğini düşünmekteyiz.

Keywords

yoğun bakım trakeostomi fiber optik bronkoskopi perkütan dilatasyonal trakeostomi Griggs mortalite

References

  • 1-Weisler MC, Couch ME. Trakeotomi ve entübasyon. In: Bailey BJ, Johnson JT, Newlands SD editors. Head & Neck Surgery – Otolaryngology. 4th ed. Ankara: Lippincott Williams & Wilkins; 2011;p 785-801.
  • 2-Jackson C. Tracheostomy. Laryngoscope 1909; 19: 285-90.
  • 3-Simpson TP, Day CJE, Jewkes CF, et al. The impact of percutaneous tracheostomy on intensive care unit practice and training. Anaesthesia. 1999;54:186–189.
  • 4-Naqvi SMA, Bashir MJ, Hussain M,et al. Percutaneous dilatational tracheostomy: A prospective analysis about the safety of procedure among ICU patients. Journal of Postgraduate Medical Institute (Peshawar – Pakistan) 2017;31(1):56–60.
  • 5-Batuwitage B, Webber S, Glossop A. Percutaneous tracheostomy. Continuing Education in Anaesthesia Critical Care & Pain. 2014;14(6):268–272.
  • 6-Yıldırım F ,Güllü YT, Demirel CB. Yoğun Bakımda Perkütan Trakeostomi. Eurasian J Pulmonol 2015.
  • 7-Friedman Y, Fildes J, Mizock B, et al. Comparison of percutaneous and surgical tracheostomies. Chest 1996;110:480-485.
  • 8-Anon JM, Gomez V, Escuela MP, et al. Percutaneous tracheostomy:Comparison of Ciaglia and Griggs techniques. Crit Care 2000;4:124-128.
  • 9-Pietkiewicz P, Machata W, Kusmierczyk K, et al. Early complications of Griggs percutaneous tracheostomy in own material. Otolarryngol Pol 2012;66:196-200.
  • 10-Gupta P, Modrykamien A. Fatal case of tension pneumothorax and subcutaneous emphysema after open surgical tracheostomy. J Intensive Care Med. 2014;29:298–301.
  • 11-Ahuja H, Mathai AS, Chander R, et al. Case of difficult tracheostomy tube insertion: A novel yet simple solution to the dilemma. Anesth Essays Res. 2013;7:402–404.
  • 12-Deganello A, Sofra MC, Facciolo F, et al. Tracheotomy-related posterior tracheal wall rupture, trans-tracheal repair. Acta Otorhinolaryngol Ital. 2007;27:258–262.
  • 13-Fikkers BG, van Veen JA, Kooloos JG,et al. Emphysema and pneumothorax after percutaneous tracheostomy: Case reports and an anatomic study. Chest. 2004;125:1805–1814.
  • 14-Duann CW, Hsieh MS, Chen PT,et al. Successful percutaneous tracheostomy via puncture through the thyroid isthmus. Respirol Case Rep. 2014;2:57–60.
  • 15-Cipriano A, Mao ML, Hon HH, et al. An overview of complications associated with open and percutaneous tracheostomy procedures. Int J Crit Illn Inj Sci 2015;5:179-188.
  • 16-Simon M, Metschke M, Braune SA, et al. Death after percutaneous dilatational tracheostomy: a systematic review and analysis of risk factors. Critical Care 2013;17:R258.
  • 17-Levent E, Sarıman N. Pnömotoraks olmaksızın pnömomediastinum ve derialtı amfizemi gelişen bronş astması olgusu. Solunum 2008; 10:131- 135.
  • 18-Karmy-Jones R, Nathens AB, Stern E. Springer Science and Business Media. Thoracic trauma and critical care. 1st ed 2012.
  • 19-Öncül S, Yılmaz M, Gaygusuz E, et al. Our experience in percutaneous tracheostomy which performed by Griggs method: 38 cases. Medical Journal of Kocaeli 2014; 2:1-4.
  • 20-Barba CA, Angood PB, Kauder DR, et al. Bronchoscopic guidance makes percutaneous tracheostomy a safe, cost-effective, and easy-to-teach procedure. Surgery 1995;118:879-883.
  • 21-Maddali MM, Pratap M, Fahr J, et al. Percutaneous tracheostomy by guidewire dilating forceps technique: review of 98 patients. J Postgrad Med 2001;47:100-103.
  • 22-Gobatto AL, Besen BA, Tierno PF. Ultrasound-guided percutaneous dilational tracheostomy versus bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients (TRACHUS): a randomized noninferiority controlled trial. Intensive Care Med 2016;42:342.
There are 22 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Original research article
Authors

Mustafa Özgür Cırık 0000-0002-9449-9302

Güler Eraslan Doğanay 0000-0003-2420-7607

Publication Date August 31, 2021
Submission Date December 4, 2020
Published in Issue Year 2021

Cite

AMA Cırık MÖ, Eraslan Doğanay G. Yoğun Bakım Ünitesinde Fiberoptik Bronkoskopi Eşliğinde Uygulanan Perkütan Trakeostomilerin Retrospektif Değerlendirilmesi. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. August 2021;54(2):232-237. doi:10.20492/aeahtd.835948