Trottier Steven J, Ritter Steven, Lakshmanan Rekha, Sakabu Stanley A, Troop Bryan R
Department of Critical Care Medicine, St. John's Mercy Medical Center, St. Louis University, Tower B 4006, 621 South New Ballas Road, St. Louis, MO 63141, USA.
Chest. 2002 Oct;122(4):1377-81. doi: 10.1378/chest.122.4.1377.
To determine the patency of standard and modified Portex tracheostomy tubes inserted by the percutaneous dilatational technique.
Prospective observational study.
Medical-surgical ICUs in a tertiary care community hospital.
Medical-surgical ICU patients requiring tracheostomy.
Consecutive medical-surgical ICU patients requiring tracheostomy were eligible for the study. Percutaneous tracheostomy tubes were inserted using the percutaneous dilatational technique with bronchoscopic guidance. The study population consisted of the following two groups: group 1 (receiving the standard Portex Per-fit percutaneous tracheostomy tube); and group 2 (receiving the modified Portex Per-fit percutaneous tracheostomy tube). Patients underwent daily fiberoptic evaluation to assess tracheostomy tube patency following the first 72 h after the tracheostomy tube placement. Demographic data and clinical signs or symptoms of airway obstruction were recorded.
Thirty-seven patients received the standard percutaneous tracheostomy tube (group 1), and 17 patients received the modified percutaneous tracheostomy tube (group 2). Partial tracheostomy tube occlusion (> 25%) was observed in 21 of 37 group 1 patients (57%) and in 1 of 17 group 2 patients (6%; p < 0.005). Fifteen of 37 group 1 patients (41%) and none of the group 2 patients sustained a > or = 40% occlusion of the distal tracheostomy tube opening (p < 0.005). One patient from group 1 had clinical manifestations of tracheostomy tube obstruction. None of the patients in group 2 experienced signs or symptoms of airway obstruction.
The standard Portex Per-fit percutaneous tracheostomy tubes used in this study were associated with partial airway obstruction. Modifications of the standard Portex percutaneous tracheostomy tube markedly decreased the airway obstruction. Due to the findings in this study, the authors recommend abandoning the continued use of the Portex Per-fit percutaneous tracheostomy tube in its current configuration and replacing it with the modified tracheostomy tube described in this study.
确定经皮扩张技术插入的标准型和改良型Portex气管切开导管的通畅情况。
前瞻性观察性研究。
一家三级护理社区医院的内科-外科重症监护病房。
内科-外科重症监护病房中需要气管切开的患者。
连续的内科-外科重症监护病房中需要气管切开的患者符合本研究条件。在支气管镜引导下使用经皮扩张技术插入经皮气管切开导管。研究人群包括以下两组：第1组（接受标准的Portex Per-fit经皮气管切开导管）；第2组（接受改良的Portex Per-fit经皮气管切开导管）。气管切开导管置入后的前72小时后，患者每天接受纤维支气管镜评估以评估气管切开导管的通畅情况。记录人口统计学数据以及气道阻塞的临床体征或症状。
37例患者接受了标准经皮气管切开导管（第1组），17例患者接受了改良经皮气管切开导管（第2组）。第1组37例患者中有21例（57%）观察到气管切开导管部分阻塞（>25%），第2组17例患者中有1例（6%）出现这种情况（p<0.005）。第1组37例患者中有15例（41%）远端气管切开导管开口阻塞≥40%，第2组患者中无1例出现这种情况（p<0.005）。第1组有1例患者出现气管切开导管阻塞的临床表现。第2组患者均未出现气道阻塞的体征或症状。
本研究中使用的标准Portex Per-fit经皮气管切开导管与部分气道阻塞有关。标准Portex经皮气管切开导管的改良显著降低了气道阻塞。基于本研究的结果，作者建议停止继续使用当前配置的Portex Per-fit经皮气管切开导管，并用本研究中描述的改良气管切开导管取而代之。
