Yoğun Bakım Ünitesinde Fiberoptik Bronkoskopi Kılavuzluğunda Perkütan Dilatasyonel Trakeostomiye Karşı Klasik Kör Perkütan Dilatasyonel Trakeostomi: Komplikasyonlar, Mortalite ve Sonuçlar

Year 2023, , 273 - 278, 30.12.2023

Kadir Arslan , Ebru Kaya , Ayça Sultan Şahin

https://doi.org/10.18678/dtfd.1350474

Abstract

Amaç: Bu çalışmanın amacı, fiberoptik bronkoskopi (FOB) kılavuzluğu ile klasik kör teknikle gerçekleştirilen perkütan dilatasyonel trakeostomi (PDT) işlemlerinin komplikasyonlar, mortalite ve hasta sonuçları açısından karşılaştırılmasıdır.
Gereç ve Yöntemler: Bu çalışmaya Ekim 2022 ile Haziran 2023 tarihleri arasında yoğun bakım ünitesinde (YBÜ) mekanik ventilatör desteği alan 62 hasta dahil edildi. Hastalar FOB kılavuzluğunda PDT gerçekleştirilenler (grup FOB, n=31) ve klasik kör teknikle PDT gerçekleştirilenler (grup C, n=31) olarak iki gruba randomize edildi. Demografik veriler, klinik özellikler, PDT işlem süreleri, komplikasyonlar ve mortaliteler analiz edildi.
Bulgular: Ortanca yaş 64 (aralık, 19-94) yıl ve hastaların %67,7’si (n=42) erkek idi. Gruplar arasında demografik verilerin benzer olduğu saptandı. PDT işlemi gerçekleştirilen hastalarda en sık primer tanı intrakranyal hemorajiler (%32,3; n=20) idi. Tüm çalışma grubunda medyan trakeostomi açılma zamanı 13 (aralık, 3-31) gün iken gruplar arasında anlamlı bir farklılık yoktu (p=0,637). Ortalama PDT işlem süresi (9,6±3,8’e karşı 12,6±5,4 dakika, p=0,015), ortanca YBÜ kalış süresi (26’ya karşı 37 gün, p=0,004) ve komplikasyon oranı (%6,4’e karşı %25,8; p=0,038) grup FOB’da anlamlı olarak daha düşük saptandı. Tüm çalışma grubunda 28 günlük mortalite %17,7 (n=11) iken gruplar arasında anlamlı bir farklılık yoktu (p=0,740).
Sonuç: FOB kılavuzluğunda gerçekleştirilen PDT işlemlerinde, işlem süresi, YBÜ kalış süresi ve işleme bağlı görülen komplikasyon oranları anlamlı olarak düşük saptanırken, mortalite açısından anlamlı bir farklılık görülmedi.

Keywords

Trakeostomi, Bronkoskopi, Yoğun bakım ünitesi, mekanik ventilasyon, ventilatörden ayrılma

Classical Blind Percutaneous Dilatational Tracheostomy vs Fiberoptic Bronchoscopy Guided Percutaneous Dilatational Tracheostomy in the Intensive Care Unit: Complications, Mortality, and Outcomes

Abstract

Aim: This study aimed to compare percutaneous dilatational tracheostomy (PDT) procedures performed with fiberoptic bronchoscopy (FOB) guidance and classical blind technique regarding complications, mortality, and patient outcomes.
Material and Methods: This study included 62 patients receiving mechanical ventilator support in the intensive care unit (ICU) between October 2022 and June 2023. Patients were randomized into two groups: those who underwent FOB-guided PDT (group FOB, n=31) and those who underwent PDT with the classical blind technique (group C, n=31). Demographic data, clinical characteristics, PDT procedure times, complications, and mortalities were analyzed.
Results: The median age was 64 (range, 19-94) years, and 67.7% (n=42) of the patients were male. Demographic data were found similar between groups. The most common primary diagnosis in patients who underwent PDT was intracranial hemorrhages (32.3%, n=20). While the median tracheostomy opening time in the entire study group was 13 (range, 3-31) days, there was no significant difference between the groups (p=0.637). The mean PDT procedure time (9.6±3.8 vs 12.6±5.4 min, p=0.015), median ICU stay (26 vs 37 days, p=0.004), and complication rate (6.4% vs 25.8%, p=0.038) were found to be significantly lower in group FOB. While the 28-day mortality in the entire study group was 17.7% (n=11), there was no significant difference between the groups (p=0.740).
Conclusion: In PDT procedures performed under FOB guidance, procedure time, length of stay in the ICU, and procedure-related complication rates were significantly lower, while no significant difference was observed in terms of mortality.

Keywords

Tracheostomy, Bronchoscopy, Intensive care unit, mechanical ventilation, ventilator weaning

References

• Griggs WM, Myburgh JA, Worthley LI. A prospective comparison of a percutaneous tracheostomy technique with standard surgical tracheostomy. Intensive Care Med. 1991;17(5):261-3.
• Durbin CG Jr. Tracheostomy: why, when, and how? Respir Care. 2010;55(8):1056-68.
• Düger C, İsbir AC, Uysal İÖ, Özdemir Kol İ, Kaygusuz K, Gürsoy S, et al. The evaluation of the complications of surgical and percutaneous tracheostomies in intensive care unit. Turk J Anaesthesiol Reanim. 2013;41(3):84-7. Turkish.
• Al-Ansari MA, Hijazi MH. Clinical review: percutaneous dilatational tracheostomy. Crit Care. 2006;10(1):202.
• Yıldırım F, Güllü YT, Demirel CB. Percutaneous tracheostomy in the intensive care unit. Eurasian J Pulmonol. 2015;17(3):136-41.
• Memmedova F, Ger Akarsu F, Mehdiyev Z, Aykaç Ö, Pınarbaşlı MÖ, Gürbüz MK, et al. Evaluation of percutaneous and surgical tracheostomy results in neurocritical care unit. Turk J Neurol. 2022;28(1):31-7.
• Arslan K, Sahin AS, Yalcın N, Kaya E. Evaluation of trauma patients followed up and treated in intensive care unit: the sample of Istanbul province training and research hospital. Turk J Intensive Care. 2023;21(1):41-7.
• Gucyetmez B, Atalan HK, Cakar N; Turkish Tracheotomy Survey Group. Elective tracheotomy practices in Turkey. PLoS One. 2016:11(11):e0166097.
• Decker S, Gottlieb J, Cruz DL, Müller CW, Wilhelmi M, Krettek C, et al. Percutaneous dilatational tracheostomy (PDT) in trauma patients: a safe procedure. Eur J Trauma Emerg Surg. 2016;42(5):605-10.
• Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA. 2010;303(15):1483-9.
• Young D, Harrison DA, Cuthbertson BH, Rowan K; TracMan Collaborators. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA. 2013;309(20):2121-9.
• Gupta S, Tomar DS, Dixit S, Zirpe K, Choudhry D, Govil D, et al. Dilatational percutaneous vs surgical tracheostomy in intensive care unit: a practice pattern observational multicenter study (DISSECT). Indian J Crit Care Med. 2020;24(7):514-26.
• Romero CM, Cornejo R, Tobar E, Galvez R, Luengo C, Estuardo N, et al. Fiber optic bronchoscopy-assisted percutaneous tracheostomy: a decade of experience at a university hospital. Rev Bras Ter Intensiva. 2015;27(2):119-24.
• Batcik S, Süren M, Cömlekci M, Özdamar M, Özdemir H, Fadıllıoğlu S, et al. Comparison of patients undergoing tracheostomy with and without fiberoptic bronchoscopy. Ann Clin Anal Med. 2021;12(Suppl 3):S333-7.
• Shen G, Yin H, Cao Y, Zhang M, Wu J, Jiang X, et al. Percutaneous dilatational tracheostomy versus fibreoptic bronchoscopy-guided percutaneous dilatational tracheostomy in critically ill patients: a randomised controlled trial. Ir J Med Sci. 2019;188(2):675-81.
• Ravi PR, Vijay MN. Real time ultrasound-guided percutaneous tracheostomy: is it a better option than bronchoscopic guided percutaneous tracheostomy? Med J Armed Forces India. 2015;71(2):158-64.
• Karvandian K, Mahmoodpoor A, Beigmohammadi M, Sanaie S. Complications and safety of percutaneous dilatational tracheostomy with Griggs method versus surgical tracheostomy: A prospective trial with six months follow-up. Pak J Med Sci. 2009;25(1):41-5.
• Saritas A, Saritas PU, Kurnaz MM, Beyaz SG, Ergonenc T. The role of fiberoptic bronchoscopy monitoring during percutaneous dilatational tracheostomy and its routine use into tracheotomy practice. J Pak Med Assoc. 2016;66(1):83-9.
• Dennis BM, Eckert MJ, Gunter OL, Morris JA Jr, May AK. Safety of bedside percutaneous tracheostomy in the critically ill: Evaluation of more than 3,000 procedures. J Am Coll Surg. 2013;216(4):858-65.
• Cabrini L, Monti G, Landoni G, Biondi-Zoccai G, Boroli F, Mamo D, et al. Percutaneous tracheostomy, a systematic review. Acta Anaesthesiol Scand. 2012;56(3):270-81.
• Eminoğlu S, Özgünay ŞE. Comparison of percutaneous dilatational tracheostomy via fiberoptic bronchoscopy with standard percutaneous dilatational tracheostomy: a prospective randomized trial. Med Bull Haseki. 2020;58(1):78-83. Turkish.
• Karaca Ü, Onur T, Eminoğlu S, Özgünay SE, Ata F. The comparison of ultrasonography-guided percutaneous tracheostomy with fiberoptic bronchoscopy-guided percutaneous tracheostomy: clinical experimental research. Turkiye Klinikleri J Anest Reanim. 2022;20(1):16-22. Turkish.