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

Year 2023, Volume: 25 Issue: 3, 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

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