Yoğun Bakım Ünitemizde Perkütan Yöntemle Açılan Trakeostomi Deneyimlerimiz; Retrospektif Analiz

Öz

ÖZ. Amaç: Yoğun bakım ünitemizde perkütan trakeostomi yöntemi ile açılan 58 hastayı retrospektif olarak sunmayı amaçladık. Materyal ve metod: Hastanemizin anesteziyoloji ve reanimasyon kliniği yoğun bakım ünitesinde Ocak 2017-Aralık 2020 tarihleri arasında perkütan yöntemle trakeostomi açılan hastalar retrospektif olarak incelendi. Bulgular: Çalışmaya 58 hasta dahil edildi. Hastaların yaş ortalaması 65±18,2 yıl idi. Hastaların %56,9’i erkek, % 43,1’i kadındı. Yatış tanılarına bakıldığında en sık neden nörolojik nedenler idi. Hastaların Apache II skorları ortalama 23,2±3,6 olarak bulundu. Hastaların PT açılmasına kadar geçen süre ortalama 18,3±5,1 gün, PT açılma süresi 11,1±2,4 dk, mekanik ventilatör süreleri 62,1±37,8 gün ve yoğun bakım yatış süresi 67,2±43,5 gün olarak bulundu. İşlem sırasında en sık görülen komplikasyon hipoksi ve hipotansiyon iken işlem sonrasında görülen en sık komplikasyon minör kanama olarak saptandı. Sonuç: Trakeostominin, hasta konforunu artırmak, hastaların solunum cihazından ayrılmalarını kolaylaştırmak, ölü boşluğu azaltarak pulmoner sekresyonların temizlenmesini sağlamak gibi avantajları bulunmaktadır. Perkütan trakeostomi düşük komplikasyon oranları nedeniyle daha güvenilir bir işlemdir. ABSTRACT Background: To retrospectively evaluate 58 patients who underwent percutaneous tracheostomy in our intensive care unit. Materials and Methods: The study included 58 patients that underwent percutaneous tracheostomy in the ICU at our Anesthesiology and Reanimation department between January 2017 and December 2020. Results: The percutaneous tracheostomy group comprised 33 (56.9%) men and 25 (43.1%) women with a mean age of 65±18.2 (range, 19-90) years. Most common primary diagnosis of hospitalization was neurological disorders (51.7%). Mean APACHE II score was 23.2±3.6, mean time to percutaneous tracheostomy was 18.3±5.1 (range, 7-30) days, mean procedural time was 11.1±2.4 min, mean duration of mechanical ventilation was 62.1±37.8 (range, 15-167) days, mean intensive care unit stay was 67.2±43.5 (range, 15-247) days, and mean hospitalization time was 77.5±50.4 (range, 15-277) days. Hypoxia and hypotension were the most common intraoperative complications and minor bleeding was the most common postoperative complication. Conclusions: Performing early tracheostomy in intensive care unit patients requiring prolonged mechanical ventilation increases patient comfort, facilitates discontinuation of mechanical ventilation, reduces the dead space, facilitates the clearing of airway secretions, and shortens the duration of intensive care unit and hospital stay. Additionally, percutaneous tracheostomy was revealed as a safe procedure for intensive care unit patients due to its lower complication rates.

Anahtar Kelimeler

• Perkütan trakeostomi
• komplikasyon
• yoğun bakım

Our Percutaneous Tracheostomy Experience in Our Intensive Care Unit: A Retrospective Analysis

Öz

Background: To retrospectively evaluate 58 patients who underwent percutaneous tracheostomy in our intensive care unit.
Materials and Methods: The study included 58 patients that underwent percutaneous tracheostomy in the ICU at our Anesthesiology and Reanimation department between January 2017 and December 2020.
Results: The percutaneous tracheostomy group comprised 33 (56.9%) men and 25 (43.1%) women with a mean age of 65±18.2 (range, 19-90) years. Most common primary diagnosis of hospitalization was neurological disorders (51.7%). Mean APACHE II score was 23.2±3.6, mean time to percutaneous tracheostomy was 18.3±5.1 (range, 7-30) days, mean procedural time was 11.1±2.4 min, mean duration of mechanical ventilation was 62.1±37.8 (range, 15-167) days, mean intensive care unit stay was 67.2±43.5 (range, 15-247) days, and mean hospitalization time was 77.5±50.4 (range, 15-277) days. Hypoxia and hypotension were the most common intraoperative complications and minor bleeding was the most common postoperative complication.
Conclusions: Performing early tracheostomy in intensive care unit patients requiring prolonged mechanical ventilation increases patient comfort, facilitates discontinuation of mechanical ventilation, reduces the dead space, facilitates the clearing of airway secretions, and shortens the duration of intensive care unit and hospital stay. Additionally, percutaneous tracheostomy was revealed as a safe procedure for intensive care unit patients due to its lower complication rates.

Anahtar Kelimeler

• Percutaneous tracheostomy
• complication
• intensive care unit

Kaynakça

1. Referans1. Düger C, İsbir AC, Uysal İÖ, Kol İÖ, 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;41:84-7. doi: 10.5152/TJAR.2013.31.
2. Referans2. Pappas S, Maragoudakis P, Vlastarakos P, Assimakopoulos D, Mandrali T, Kandilotos D, et al. Surgical versus percutaneous tracheostomy: an evidence-based approach. Eur Arch Otorhinolaryngol 2011;268(3):323-30. doi: 10.1007/s00405-010-1398-5.
3. Referans3. Sağıroğlu AE, Ağkoç E, Doğan Y, ve ark. Yoğun bakım ünitesinde perkütan ve cerrahi trakeostominin karşılaştırılması. Göztepe Tıp Dergisi 2010;25(2):67-70,2010 doi:10.5222/J.GOZTEPETRH.2010.067.
4. Referans4. Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy. A simple bedside procedure; Preliminary report. Chest 1985;87(6):715-9. doi: 10.1378/chest.87.6.715.
5. Referans5. Griggs WM, Worley LI, Gilligan JE, Thomas PD, Myburg JA. A simple percutaneous tracheostomy technique. Surg Gynecol Obstet 1990;170(6):543-545.
6. Referans6. Ak K. Perkütan Trakeostomi. Tıp Araştırmaları Dergisi 2016:14(1):67-73.
7. Referans7. Totoz T, Türk HŞ, Sayın P, Ünsal O, Çınar S, Oba S. Yoğun bakım ünitemizdeki (YBÜ) perkütan trakeotomi pratiğimiz. Ş.E.E.A.H. Tıp Bülteni 2013;47(1):11-5. doi: 10.5350/SEMB2013470103.
8. Referans8. Akıncı SB, Kanbak M, Aypar Ü. Perkütan trakeostomi. Yoğun Bakım Dergisi 2003;3(3):149-59.

9. Referans9. Çanakçı E, Şahin AE, Kılıç K. Percutaneous tracheostomy with Grigss dilating forceps technique: Retrospective analysis of 60 intensive care patients. Ege Journal of Medicine 2016;55(4):184-9. doi: 10.19161/etd.344223.
10. Referans10. François B, Clavel M, Desachy A, Puyraud S, Roustan J, Vignon P. Complications of tracheostomy performed in the ICU: subthyroid tracheostomy vs surgical cricothyroidotomy. Chest 2003;123(1):151-8. doi: 10.1378/chest.123.1.151.
11. Referans11. Öncül S, Yılmaz M, Gaygusuz EA, Oysu DA, Esen O, Şimşek T, et al. Our experience in percutaneous tracheostomy which performed by Griggs method: 38 cases. Medical Journal of Kocaeli 2014;3(2):1-4.
12. Referans12. Ersoy A, Ali A, Ünlü N, Kara D, Turgut N. Griggs Yöntemi ile Gerçekleştirilen 53 Perkütan Trakeostomi. Okmeydanı Tıp Dergisi 2012;28(3):134-7. doi:10.5222/otd.2012.134.
13. Referans13. Karasu D, Yılmaz C, Baytar Ç, Korfalı G. Yoğun Bakım Ünitemizde Perkütan Yöntemle Açılan Trakeostomi Olgularının Retrospektif Analizi. Turk J Intensive Care 2018;16(3):83-7. doi: 10.4274/tybd.73644.
14. Referans14. Scales DC, Thiruchelvam D, Kiss A, Redelmeier DA. The effect of tracheostomy timing during critical illness on long-term survival. Crit Care Med 2008;36(9):2547-57. doi: 10.1097/CCM.0b013e31818444a5.
15. Referans15. 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. doi: 10.1001/jama.2010.447.
16. Referans16. Zheng Y, Sui F, Chen XK, Zhang GC, Wang XW, Zhao S, et al. Early versus late percutaneous dilational tracheostomy in critically ill patients anticipated requiring prolonged mechanical ventilation. Chin Med J (Engl) 2012;125(11):1925-30. doi: 10.3760/cma.j.issn.0366-6999.2012.11.016.
17. Referans17. Kearney PA, Griffen MM, Ochoa JB, Boulanger BR, Tseui BJ, Mentzer RM Jr: A single-center 8-year experience with percutaneous dilatational tracheostomy. Ann Surg 2000;231(5):701-9. doi: 10.1097/00000658-200005000-00010.
18. Referans18. Halum SL, Ting JY, Plowman EK, Belafsky PC, Harbarger CF,Postma GN, Pitman MJ, LaMonica D, Moscatello A, Khosla S, Cauley CE, Maronian NC, Melki S, Wick C, Sinacori JT,White Z, Younes A, Ekbom DC, Sardesai MG, Merati AL.A multi-institutional analysis of tracheotomy complications. Laryngoscope. 2012 Jan;122(1):38-45. doi: 10.1002/lary.22364
19. Referans19. Destegül D, Kocaöz FŞ, Kuşçu ÖÖ. Yoğun bakımda perkütan ve cerrahi trakeostomi deneyimlerimiz. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 2020;22(2):192-198. doi: 10.24938/kutfd.671205.