Cantais Emmanuel, Kaiser Eric, Le-Goff Yann, Palmier Bruno
Service de Réanimation, Hopital d'Instruction des Armées Sainte Anne, Military Teaching Hospital, Toulon, France.
Crit Care Med. 2002 Apr;30(4):815-9. doi: 10.1097/00003246-200204000-00016.
To compare two different techniques of percutaneous tracheostomy: Griggs' forceps-dilational technique and Fantoni's translaryngeal technique, both performed with the manufacturer's basic kit and with bronchoscopic guidance.
A prospective, randomized trial was designed to compare the two tracheostomy techniques. Critically ill patients requiring elective tracheostomy for long-term ventilation were randomized for translaryngeal tracheostomy or forceps-dilational tracheostomy.
Intensive care unit of a military teaching hospital.
A total of 100 adult patients in the intensive care unit who were mechanically ventilated.
All tracheostomy procedures were performed at the bedside by using a commercially available set. The procedures were performed by two surgeons, one for bronchoscopic guidance and management of the airway and one for the tracheostomy.
The measurements were divided into procedure-related variables (duration, technical difficulties, oxygenation): major and minor complications. The procedure was longer in the translaryngeal technique group (12.9 vs. 6.9 mins, p =.0018). Technical difficulties occurred in 11 patients in the translaryngeal technique group. Uneventful forceps dilational tracheostomy was performed instead. There has been no mortality associated with either technique. Serious complications occurred in one patient in the forceps-dilational technique group (one posterior tracheal wall injury) and in four patients in the translaryngeal technique group (one with a posterior tracheal wall injury and three with severe hypoxia). Significant hypercarbia and acidosis occurred in both the translaryngeal technique group and the forceps-dilational technique group. A significant decrease in Pao2 was observed in the translaryngeal technique group (311 to 261, p =.0069). No bleeding requiring intervention occurred.
Serious complications related to percutaneous tracheostomy occurred in 8.5% and 1.8% of the cases in the translaryngeal technique and the forceps-dilational technique group, respectively (p <.001). Technical difficulties were not rare when using the translaryngeal technique (23%). On the basis of our results, we concluded that the forceps-dilation technique is superior to the translaryngeal technique, with fewer technical difficulties and fewer complications for critically ill patients.
比较两种不同的经皮气管切开技术：格里格斯钳扩张技术和法托尼经喉技术，均使用制造商的基本套件并在支气管镜引导下进行。
设计一项前瞻性随机试验以比较两种气管切开技术。因长期通气需要择期气管切开的重症患者被随机分为经喉气管切开组或钳扩张气管切开组。
一家军队教学医院的重症监护病房。
重症监护病房中总共100例接受机械通气的成年患者。
所有气管切开手术均在床边使用市售套件进行。手术由两名外科医生进行，一名负责支气管镜引导和气道管理，另一名负责气管切开。
测量指标分为与手术相关的变量（持续时间、技术难度、氧合）：主要和次要并发症。经喉技术组的手术时间更长（12.9分钟对6.9分钟，p = 0.0018）。经喉技术组有11例患者出现技术困难。改为进行顺利的钳扩张气管切开术。两种技术均未导致死亡。钳扩张技术组有1例患者发生严重并发症（1例气管后壁损伤），经喉技术组有4例患者发生严重并发症（1例气管后壁损伤和3例严重缺氧）。经喉技术组和钳扩张技术组均出现明显的高碳酸血症和酸中毒。经喉技术组观察到动脉血氧分压显著下降（311至261，p = 0.0069）。未发生需要干预的出血情况。
经皮气管切开相关的严重并发症在经喉技术组和钳扩张技术组中的发生率分别为8.5%和1.8%（p < 0.001）。使用经喉技术时技术困难并不罕见（23%）。根据我们的结果，我们得出结论，钳扩张技术优于经喉技术，对于重症患者技术困难更少且并发症更少。
