Bronkoskopi Kılavuzluğunda Perkütan Dilatasyonel Trakeostomi: Tek Merkez Deneyimi

Year 2025, Volume: 8 Issue: 1, 67 - 72

Baris Ecevit Yuksel , Omer Zuhtu Yondem , Orhun Demir

Abstract

Giriş
Perkütan dilatasyonel trakeostomi (PDT), uzun süreli mekanik ventilasyon gereksinimi olan hastalarda yoğun bakım ünitelerinde (YBÜ) sık yapılan bir işlemdir. Bu çalışmanın amacı, fiberoptik bronkoskopi rehberliğinde yapılan PDT’nin erken ve geç trakeostomi zamanlaması açısından sonuçlarını değerlendirmektir.
Materyal ve Metot
Bu retrospektif çalışmada, fiberoptik bronkoskopi rehberliğinde PDT uygulanan 57 hasta analiz edilmiştir. Hastaların demografik verileri, Glasgow Koma Skalası (GKS) skorları, APACHE II skorları, mekanik ventilasyon süresi ve komplikasyonlar değerlendirilmiştir.
Bulgular
57 hastanın %29,8’ine erken trakeostomi, %70,2’sine ise geç trakeostomi uygulanmıştır. Yaş, cinsiyet, GKS ve APACHE II skorları açısından gruplar arasında anlamlı bir fark bulunmamıştır. YBÜ’de kalış süresi, mortalite ve ventilatörden ayrılma açısından da gruplar arasında anlamlı bir fark tespit edilmemiştir. Minör komplikasyonların insidansı gruplar arasında benzerdir.
Sonuç
Çalışma, erken ve geç trakeostomi grupları arasında klinik sonuçlar açısından anlamlı bir fark olmadığını göstermiştir. Bronkoskopi işlemin güvenliğini artırmış ancak komplikasyon oranlarını anlamlı ölçüde etkilememiştir. PDT zamanlaması, klinik değerlendirme ve hastanın durumuna göre bireyselleştirilmelidir. Optimal zamanlama yönergelerini belirlemek için daha geniş kapsamlı çalışmalara ihtiyaç vardır.

Keywords

Perkütan Dilatasyonel Trakeostomi, Fiberoptik Bronkoskopi, Mekanik Ventilasyon, Yoğun Bakım Ünitesi, Trakeostomi Zamanlaması

Bronchoscopic-Guided Percutaneous Dilatational Tracheostomy: A Single-Center Experience

Abstract

Introduction
Percutaneous dilatational tracheostomy (PDT) is a common procedure in intensive care units (ICUs) for patients requiring prolonged mechanical ventilation. This study aims to evaluate the outcomes of PDT under fiberoptic bronchoscopy guidance, comparing early versus late tracheostomy timing.
Materials and Methods
This retrospective study analyzed 57 patients who underwent PDT with fiberoptic bronchoscopy guidance. Patient demographics, Glasgow Coma Scale (GCS) scores, APACHE II scores, duration of mechanical ventilation, and complications were assessed.
Results
Of the 57 patients, 29.8% underwent early tracheostomy, and 70.2% underwent late tracheostomy. No significant differences were found in terms of age, gender, or GCS and APACHE II scores between the two groups. No significant differences in ICU length of stay, mortality, or weaning from ventilator were observed between the groups. The incidence of minor complications were similar between the two groups.
Conclusion
The study found no significant difference in clinical outcomes between early and late tracheostomy groups. While bronchoscopy enhanced procedural safety, it did not impact complication rates significantly. The timing of PDT should be individualized based on clinical judgment and patient condition. Tracheostomy timing should be tailored to each patient’s condition, and larger studies are needed to define optimal timing guidelines.

Keywords

Percutaneous Dilatational Tracheostomy, Fiberoptic Bronchoscopy, Mechanical Ventilation, ICU, Timing of Tracheostomy

Ethical Statement

The ethics committee approval was taken from the Lokman Hekim University Ethics Committee (Date: 29/11/2024, No: 2024/275).

Thanks

The authors acknowledge Prof. Dr. Mehmet Doganay from Lokman Hekim University, Ankara, Turkey for critical suggestions and review.

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