Bronkoskopi Kılavuzluğunda Perkütan Dilatasyonel Trakeostomi: Tek Merkez Deneyimi

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Etik Beyan

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

Teşekkür

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

Kaynakça

1. 1.Pappas S, Maragoudakis P, Vlastarakos P, et al. Surgical versus percutaneous tracheostomy: an evidence-based approach. European Archives of Oto-Rhino-Laryngology. 2011;268(3):323-330. https://doi.org/10.1007/s00405-010-1398-5
2. 2.Duger C, Isbir AC, Uysal IO, et al. The Evaluation of the Complications of Surgical and Percutaneous Tracheostomies in Intensive Care Unit. Turk J Anaesthesiol Reanim. 2020;41(3):84-87. https://doi.org/10.5152/TJAR.2013.31
3. 3.Griggs WM, Worthley LI, Gilligan JE, Thomas PD, Myburg JA. A simple percutaneous tracheostomy technique. Surg Gynecol Obstet 1990 Jun;170(6):543-5 PMID: 2343371. Published online 1990.
4. 4.Totoz T, Türk HŞ, Sayın P, Ünsal O, Çınar S, Oba S. Yoğun bakım ünitemizdeki (YBÜ) perkütan trakeotomi pratiğimiz. SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital. Published online March 27, 2013:11-15. https://doi.org/10.5350/SEMB2013470103 5.Mehta C, Mehta Y. Percutaneous tracheostomy. Ann Card Anaesth. 2017;20(5):19. https://doi.org/10.4103/0971-9784.197793
5. 6.Koc A. Percutaneous Dilatational Tracheostomy with Bronchoscopic Guidance in Intensive Care Unit. Journal of Anesthesiology and Reanimation Specialists' Society. 2022;30(4):245-249. https://doi.org/10.54875/jarss.2022.49344
6. 7.Abbott F, Ortega M, Bravo S, Basoalto R, Kattan E. Can we improve teaching and learning of percutaneous dilatational tracheostomy's bronchoscopic guidance? SAGE Open Med. 2021;9. https://doi.org/10.1177/20503121211002321
7. 8.Rajasekaran S, Paul AL, Varaham R, Balaraman K, Balasubramani V. Safety and Feasibility of Very Early Bronchoscopy-assisted Percutaneous Dilatational Tracheostomy in Anterior Cervical Spine Fixation Patients. Indian Journal of Critical Care Medicine. 2022;26(10):1086-1090. https://doi.org/10.5005/jp-journals-10071-24322
8. 9.Li C, Wang T, Sheng D, Zhang M, Zheng M, Li X. Association Between Timing of Percutaneous Dilatational Tracheotomyand Clinical Outcomes of Critically-ill Elderly Patients. Journal of the College of Physicians and Surgeons Pakistan. 2024;34(02):222-225. https://doi.org/10.29271/jcpsp.2024.02.222

9. 10.Min SK, Lee JY, Lee SH, et al. Epidemiology, timing, technique, and outcomes of tracheostomy in patients with trauma: a multi‐centre retrospective study. ANZ J Surg. Published online December 26, 2024. https://doi.org/10.1111/ans.19356
10. 11.Raimondi N, Vial MR, Calleja J, et al. Evidence-based guidelines for the use of tracheostomy in critically ill patients. J Crit Care. 2017;38:304-318. https://doi.org/10.1016/j.jcrc.2016.10.009
11. 12.Bösel J, Schiller P, Hook Y, et al. Stroke-Related Early Tracheostomy Versus Prolonged Orotracheal Intubation in Neurocritical Care Trial (SETPOINT). Stroke. 2013;44(1):21-28. https://doi.org/10.1161/STROKEAHA.112.669895
12. 13.Andriolo BN, Andriolo RB, Saconato H, Atallah ÁN, Valente O. Early versus late tracheostomy for critically ill patients. Cochrane Database of Systematic Reviews. 2015;2018(12). https://doi.org/10.1002/14651858.CD007271.pub3
13. 14.Filice G, Patel P, Kata P, et al. An Overview of Outcomes Associated With Early Versus Late Tracheostomy From a National Standpoint. Cureus. Published online July 12, 2021. https://doi.org/10.7759/cureus.16325
14. 15.Patel R, Gandhi K, Dzioba A, et al. Long‐Term Follow‐up of Percutaneous Dilatational Tracheostomy in the Intensive Care Unit. Laryngoscope. Published online February 12, 2025. https://doi.org/10.1002/lary.32040
15. 16.Nikbakhsh N, Amri F, Monadi M, Amri P, Bijani A. Semi-surgical percutaneous dilatational tracheostomy vs. conventional percutaneous dilatational tracheostomy: A prospective randomized trial. Caspian J Intern Med. 2021;12(3):249-255.
16. 17.Jackson LSM, Davis JW, Kaups KL, et al. Percutaneous Tracheostomy: To Bronch or Not to Bronch-That Is the Question. Journal of Trauma: Injury, Infection & Critical Care. 2011;71(6):1553-1556. https://doi.org/10.1097/TA.0b013e31823ba29e
17. 18.Abdulla S, Conrad A, Vielhaber S, Eckhardt R, Abdulla W. Should a percutaneous dilational tracheostomy be guided with a bronchoscope? B-ENT. 2013;9(3):227-234.
18. 19.Ray B, Sinha S. Griggs percutaneous tracheostomy without bronchoscopic guidance is a safe method: A case series of 300 patients in a tertiary care Intensive Care Unit. Indian Journal of Critical Care Medicine. 2014;18(12):778-782. https://doi.org/10.4103/0972-5229.146303
19. 20.Simon M, Metschke M, Braune SA, Püschel K, Kluge S. Death after percutaneous dilatational tracheostomy: a systematic review and analysis of risk factors. Crit Care. 2013;17(5):R258. https://doi.org/10.1186/cc13085
20. 21.Silvester W, Goldsmith D, Uchino S, et al. Percutaneous versus surgical tracheostomy: A randomized controlled study with long-term follow-up*. Crit Care Med. 2006;34(8):2145-2152. https://doi.org/10.1097/01.CCM.0000229882.09677.FD
21. 22.Kluge S, Baumann HJ, Maier C, et al. Tracheostomy in the Intensive Care Unit: A Nationwide Survey. Anesth Analg. 2008;107(5):1639-1643. doi:10.1213/ane.0b013e318188b818 https://doi.org/10.1213/ane.0b013e318188b818
22. 23.Young D, Harrison DA, Cuthbertson BH, Rowan K, TracMan Collaborators for the. Effect of Early vs Late Tracheostomy Placement on Survival in Patients Receiving Mechanical Ventilation. JAMA. 2013;309(20):2121. https://doi.org/10.1001/jama.2013.5154