YOĞUN BAKIMDA PERKÜTAN VE CERRAHİ TRAKEOSTOMİ DENEYİMLERİMİZ

Öz

Amaç: Bu çalışmada perkütan ve cerrahi yöntemlerle trakeostomi açılan 168 hastanın retrospektif sunulması amaçlandı.

Gereç ve Yöntemler: Çalışmada Ocak 2015-Aralık 2017 tarihleri arasında Niğde Ömer Halisdemir Üniversitesi Eğitim ve Araştırma Hastanesi 3. Basamak Yoğun Bakım Ünitesinde trakeostomi açılan hastaların demografik verileri, yatış tanısı, yatış süresi, entübasyon süresi, entübasyondan trakeostomi açılana kadar geçen süre, işlem süresi, trakeostominin erken ve geç komplikasyonları, Acute Physiology and Chronic Health Evaluation II Score (APACHE II skoru) ile prognoz korelasyonu retrospektif olarak incelendi. Veriler, hastane veri sisteminden ve hasta dosyalarından elde edildi.

Bulgular: Çalışmaya 168 hasta dahil edildi. Yüz altmış sekiz hastanın %45.8 (n=76)’i kadın; yaş ortalaması 65.61±18.42 yıl, APACHE II skoru median 29.83±6.92 bulundu. Kronik obstrüktif akciğer hastalığı alevlenmesi, en sık yoğun bakım yatış nedeniydi (n=44, %26.2). Hastaların 126 (%75)’sına perkütan teknikle trakeostomi açılmıştı. Cerrahi teknikte majör perioperatif kanama (n=2), perkütan teknikte desatürasyon (n=4) ve trakeoözefageal fistül (n=1) görülen komplikasyonlardı. Yirmi yedi hastaya 10 günden daha kısa sürede trakeostomi açılmıştı. Trakeostomi işlemine kadar geçen süre ile yoğun bakımda ve hastanede yatış süreleri arasında korelasyon bulunmaktaydı (p<0.0001). İki grup arasında mortalite oranı açısından istatistiksel anlamlı fark bulunmamaktaydı (p=0.212).

Sonuç: Erken trakeostomi açılması, hastaların yoğun bakımda ve hastanede kalış süresini anlamlı kısaltmaktadır. Perkütan dilatasyonel trakeostomi tekniği ise yoğun bakım hastalarında elektif trakeostomi işleminde cerrahi trakeostomiye alternatif olarak tercih edilebilir.

Anahtar Kelimeler

• Trakeostomi
• yoğun bakım
• mortalite

Percutaneous and Surgical Tracheostomy Experience in Intensive Care

Öz

Objective: The aim of the study is to evaluate the patients who underwent operational and percutaneous dilatational tracheostomy.

Material and Methods: The study was conducted at the Niğde Ömer Halisdemir University Training and Research Hospital. Patients who underwent tracheostomy procedure in the Intensive Care Unit between January 2015- December 2017 were assessed retrospectively. Demographic data of the patients, diagnosis, length of stay in the intensive care unit and hospital, entubation period before the tracheostomy procedure, duration of the procedure, early and late complications of tracheostomy, correlation of APACHE II score and survival rates were recorded. Patient data were retrieved from the hospital’s database retrospectively.

Results: There were 168 patients during the study period. 45.8%of patients (n=76) were female. Mean age of the patients was 65.61±18.42 years. Median of the APACHE II score was 29.83±6.92. The most common diagnosis was chronic obstructive pulmonary disease exacerbation (n=44, 26.2%). One hundred and six patients (75%) underwent percutaneous dilatational tracheostomy procedure. While perioperative major bleeding (n=2) was the complication of surgical tracheostomy; ventilation problems (n=4) and tracheoesophageal fistula (n=1) were the complications for percutaneous dilatational tracheostomy procedure. Entubation period before the tracheostomy procedure was shorter than 10 days only for 27 patients. The entubation period and length of intensive care unit stay and hospital stay were correlated (p<0.0001). There was no statistically difference for mortality rates between two groups (p=0.212).

Conclusion: In intensive care patients, percutaneous dilatational tracheostomy technique can be preferred as an alternative to surgical tracheostomy for elective tracheostomy. Early decision of tracheostomy contributes to shortening of the length of intensive care unit stay and hospital stay.

Anahtar Kelimeler

• Tracheostomy
• intensive care unit
• mortality

Kaynakça

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