Nates J L, Cooper D J, Myles P S, Scheinkestel C D, Tuxen D V
Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
Crit Care Med. 2000 Nov;28(11):3734-9. doi: 10.1097/00003246-200011000-00034.
To prospectively compare two commonly used methods for percutaneous dilational tracheostomy (PDT) in critically ill patients.
Prospective, randomized, clinical trial.
Trauma and general intensive care units of a university tertiary teaching hospital, which is also a level 1 trauma center.
One hundred critically ill patients with an indication for PDT.
PDT with the Ciaglia technique using the Ciaglia PDT introducer set and the Griggs technique using a Griggs PDT kit and guidewire dilating forceps.
Surgical time, difficulties, and surgical and anesthesia complications were measured at 0-2 hrs, 24 hrs, and 7 days postprocedure. Groups were well matched, and there were no differences between the two methods in surgical time or in anesthesia complications. Major bleeding complications were 4.4 times more frequent with the Griggs PDT kit. With the Ciaglia PDT kit, both intraoperative and at 2 and 24 hrs, surgical complications were less common (p = .023) and the procedure was more often completed without expert assistance (p = .013). Tracheostomy bleeding was not associated with either anticoagulant therapy or an abnormal clotting profile. Multivariate analysis identified the predictors of PDT complications as the Griggs PDT kit (p = .027) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score (p = .041). The significant predictors of time required to complete PDT were the APACHE II score (p = .041), a less experienced operator (p = .0001), and a female patient (p = .013).
Patients experiencing PDT with the Ciaglia PDT kit had a lower surgical complication rate (2% vs. 25%), less operative and postoperative bleeding, and less overall technical difficulties than did patients undergoing PDT with the Griggs PDT kit. Ciaglia PDT is, therefore, the preferred technique for percutaneous tracheostomy in critically ill patients.
前瞻性比较两种常用于重症患者经皮扩张气管切开术（PDT）的方法。
前瞻性、随机临床试验。
一所大学三级教学医院的创伤和综合重症监护病房，该医院也是一级创伤中心。
100例有PDT指征的重症患者。
使用Ciaglia PDT导入器套装采用Ciaglia技术进行PDT，以及使用Griggs PDT套件和导丝扩张钳采用Griggs技术进行PDT。
在术后0 - 2小时、24小时和7天测量手术时间、困难程度以及手术和麻醉并发症。两组匹配良好，两种方法在手术时间或麻醉并发症方面无差异。使用Griggs PDT套件时，严重出血并发症的发生率高出4.4倍。使用Ciaglia PDT套件时，术中以及术后2小时和24小时，手术并发症较少见（p = 0.023），且该操作更常无需专家协助即可完成（p = 0.013）。气管切开术出血与抗凝治疗或异常凝血指标均无关。多因素分析确定PDT并发症的预测因素为Griggs PDT套件（p = 0.027）和急性生理与慢性健康状况评估（APACHE）II评分（p = 0.041）。完成PDT所需时间的显著预测因素为APACHE II评分（p = 0.041）、经验较少的操作者（p = 0.0001）和女性患者（p = 0.013）。
与使用Griggs PDT套件进行PDT的患者相比，使用Ciaglia PDT套件进行PDT的患者手术并发症发生率更低（2%对25%），术中及术后出血更少，总体技术难度更小。因此，Ciaglia PDT是重症患者经皮气管切开术的首选技术。
