Trottier S J, Hazard P B, Sakabu S A, Levine J H, Troop B R, Thompson J A, McNary R
Department of Critical Care Medicine, St. John's Mercy Medical Center, St. Louis University, MO 63141, USA.
Chest. 1999 May;115(5):1383-9. doi: 10.1378/chest.115.5.1383.
Part 1: To describe the complication of posterior tracheal wall injury and perforation associated with the percutaneous dilational tracheostomy (PDT). Part 2: To determine the mechanism of posterior tracheal wall injury during PDT.
Prospective observational study.
Part 1: Medical-surgical ICU patients requiring tracheostomy. Part 2: Swine and cadaver models.
Part 1: Consecutive medical-surgical ICU patients undergoing tracheostomy tube insertion via the percutaneous dilation technique with bronchoscopic guidance were enrolled in the study. Demographic data and complications were recorded. Part 2: Tracheostomy tubes were inserted via the percutaneous dilational technique in the swine model with concomitant bronchoscopic video recording from the proximal and distal airways. Tracheostomy tubes were inserted via the percutaneous dilational technique in the cadaver model followed by anatomic inspection of the airway.
Part 1: Seven (29%) of 24 medical-surgical ICU patients sustained complications associated with PDT. Three patients (12.5%) sustained posterior tracheal wall perforations followed by the development of tension pneumothoraces. Part 2: The swine model demonstrated that posterior tracheal wall perforation may occur during PDT when the guiding catheter is withdrawn into the dilating catheters. Five-centimeter posterior tracheal wall mucosal lacerations occurred when the guidewire and the guiding catheter were not properly stabilized during PDT.
Percutaneous dilational tracheostomy was associated with a 29% complication rate in this observational study. Of concern was the high rate (12.5%) of posterior tracheal wall perforation. The swine and cadaver models suggest that posterior tracheal wall injury or perforation may occur if the guidewire and guiding catheter are not properly stabilized. To avoid posterior tracheal wall injury, the guidewire and guiding catheter should be firmly stabilized during PDT.
第一部分：描述经皮扩张气管切开术（PDT）相关的气管后壁损伤及穿孔并发症。第二部分：确定PDT期间气管后壁损伤的机制。
前瞻性观察研究。
第一部分：需要气管切开术的内科-外科重症监护病房（ICU）患者。第二部分：猪和尸体模型。
第一部分：纳入通过经皮扩张技术在支气管镜引导下插入气管切开管的连续内科-外科ICU患者。记录人口统计学数据和并发症情况。第二部分：在猪模型中通过经皮扩张技术插入气管切开管，同时从近端和远端气道进行支气管镜视频记录。在尸体模型中通过经皮扩张技术插入气管切开管，随后对气道进行解剖检查。
第一部分：24例内科-外科ICU患者中有7例（29%）发生了与PDT相关的并发症。3例患者（12.5%）发生气管后壁穿孔，随后出现张力性气胸。第二部分：猪模型显示，当引导导管撤回至扩张导管内时，PDT期间可能发生气管后壁穿孔。当在PDT期间导丝和引导导管未妥善固定时，会出现5厘米长的气管后壁黏膜撕裂伤。
在这项观察性研究中，经皮扩张气管切开术的并发症发生率为29%。令人担忧的是气管后壁穿孔的发生率较高（12.5%）。猪和尸体模型表明，如果导丝和引导导管未妥善固定，则可能发生气管后壁损伤或穿孔。为避免气管后壁损伤，在PDT期间应牢固固定导丝和引导导管。
