Percutaneous dilatational tracheostomy in a tertiary intensive care unit: A ten-year experience from a university hospital in Türkiye

Öz

Aim: Tracheostomy provides airway patency by inserting an intratracheal cannula through a window in the anterior tracheal wall. Patients treated in intensive care units often require tracheostomy owing to prolonged endotracheal intubation and mechanical ventilation. This study aimed to evaluate the complication rates, safety, and clinical outcomes of percutaneous dilatational tracheostomy performed by anesthesiologists over a ten-year period in a tertiary intensive care unit. Material and Methods: This retrospective study was conducted between 2015 and 2024 in the Anesthesiology Intensive Care Unit of Duzce University. Among patients older than 18 years who received treatment for more than 48 h in intensive care unit, 85 who underwent bedside percutaneous dilatational tracheostomy using the Griggs technique performed by anesthesiologists were included. The patients were evaluated for demographic and clinical features, duration of ventilation and hospitalization, complications, and mortality. Results: The mean age of the patients was 72.81±16.15 years, and 65.9% were male. The most common complications were bleeding (23.5%), hypoxemia (10.6%), and pneumothorax (4.7%). None of the patients required conversion to surgical tracheostomy. Use of ultrasound, fiberoptic bronchoscopy, and laryngeal mask airway guidance was associated with a significantly lower incidence of hypoxemia (p=0.016). Conclusion: Percutaneous dilatational tracheostomy performed by anesthesiologists in the intensive care unit is a safe, practical, and effective bedside procedure, with a low rate of major complications. Ultrasound, fiberoptic bronchoscopy, and laryngeal mask airway guidance enhance procedural safety and reduce the risk of complications. Routine implementation by experienced anesthesiologists is recommended in critically ill patients requiring prolonged mechanical ventilation.

Anahtar Kelimeler

• Anesthesiologists
• bronchoscopy
• complications
• laryngeal mask airway
• tracheostomy
• ultrasonography

Üçüncü basamak yoğun bakım ünitesinde perkütan dilatasyonel trakeostomi: Türkiye’de bir üniversite hastanesinden on yıllık deneyim

Öz

Amaç: Trakeostomi, ön trakeal duvarda bir pencere açılarak intratrakeal bir kanül yerleştirilmesiyle havayolu açıklığını sağlar. Yoğun bakım ünitelerinde tedavi gören hastalar, uzamış endotrakeal entübasyon ve mekanik ventilasyon nedeniyle sıklıkla trakeostomiye ihtiyaç duyar. Bu çalışmanın amacı, üçüncü basamak bir yoğun bakım ünitesinde anesteziyologlar tarafından gerçekleştirilen perkütan dilatasyonel trakeostomi işlemlerinin on yıllık süreçteki komplikasyon oranlarını, güvenliğini ve klinik sonuçlarını değerlendirmektir. Gereç ve Yöntemler: 2015–2024 yılları arasında Düzce Üniversitesi Anesteziyoloji Yoğun Bakım Ünitesi’nde retrospektif olarak yapılan bu çalışmaya, yoğun bakımda 48 saatten uzun süre tedavi gören 18 yaş üstü hastalar arasından, anesteziyologlar tarafından Griggs tekniğiyle yatak başında perkütan dilatasyonel trakeostomi uygulanan 85 hasta dahil edilmiştir. Hastalar demografik ve klinik özellikleri, ventilasyon ve yatış süreleri, komplikasyonlar ve mortalite açısından değerlendirilmiştir. Bulgular: Hastaların yaş ortalaması 72,81±16,15 olup, %65,9’u erkekti. İşlem sırasında kanama (%23,5), hipoksemi (%10,6) ve pnömotoraks (%4,7) en sık komplikasyonlar olarak saptandı. Hiçbir vakada acil cerrahi trakeostomiye geçiş gereksinimi olmadı. Ultrason, fiberoptik bronkoskopi ve laringeal maske rehberliğinin kullanıldığı olgularda hipoksemi oranı anlamlı derecede daha düşüktü (p=0,016). Sonuç: Yoğun bakımda anesteziyologlar tarafından uygulanan perkütan dilatasyonel trakeostomi, düşük majör komplikasyon oranı ile güvenli, pratik ve etkili bir işlemdir. Ultrason, bronkoskopi ve laringeal maske kılavuzluğu, işlemin güvenliğini artırmakta ve komplikasyon oranlarını azaltmaktadır. Uzun süreli mekanik ventilasyon gerektiren kritik hastalarda, deneyimli anestezistler tarafından rutin olarak uygulanması önerilmektedir.

Anahtar Kelimeler

• Anesteziyolog
• bronkoskopi
• komplikasyonlar
• laringeal maske airway
• trakeostomi
• ultrasonografi

Kaynakça

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