Husein Omar F, Massick Douglas D
Department of Otolaryngology, The Ohio State University, Columbus, OH, USA.
Otolaryngol Head Neck Surg. 2005 Dec;133(6):839-44. doi: 10.1016/j.otohns.2005.08.008.
To prospectively evaluate the significance of cricoid cartilage palpability as a selection criterion for bedside tracheostomy and to prospectively compare a cohort of patients undergoing bedside tracheostomy with another cohort receiving operating room tracheostomy.
STUDY DESIGN/SETTING: Prospective trial comparing 2 cohorts of patients receiving tracheostomies at a tertiary care center (university hospital). In all, 220 consecutive intubated patients selected for elective tracheostomy were enrolled. Of them, 134 patients had palpable cricoid cartilage and underwent open surgical tracheostomy at the bedside. The remaining 68 patients received open surgical tracheostomies in the operating room. Demographic data, patient anatomic features, and perioperative complications were prospectively recorded. There were no statistically significant differences in age, gender, reason for admission, indication for tracheostomy, Acute Physiology and Chronic Health Evaluation II score, number of days intubated, or time required to perform the procedure for those patients whose tracheostomies were performed in the operating room versus the intensive care unit.
Patients with a palpable cricoid cartilage had a significantly reduced perioperative complication rate compared with those without a palpable cricoid cartilage (2% vs 22%, P < 0.001). Comparison of cervical girth, mental-to-sternum distance, and thyroid-notch-to-sternum distance showed no significant difference between the 2 groups and did not further define selection criteria.
This investigation prospectively confirms the safety of bedside tracheostomy placement in properly selected patients. Complication incidences are defined for open surgical tracheostomy at the bedside and in the operating room. Palpability of the cricoid cartilage has significant value as a selection criterion for bedside tracheostomy.
These findings will aid in the development of protocols and pathways for surgical airway management in critically ill patients to maximize cost-effective, high-quality care.
前瞻性评估环状软骨可触及性作为床旁气管切开术选择标准的意义，并前瞻性比较一组接受床旁气管切开术的患者与另一组接受手术室气管切开术的患者。
研究设计/地点：在一家三级医疗中心（大学医院）对两组接受气管切开术的患者进行前瞻性试验。总共纳入了220例连续入选接受择期气管切开术的插管患者。其中，134例患者环状软骨可触及，在床旁接受开放式手术气管切开术。其余68例患者在手术室接受开放式手术气管切开术。前瞻性记录人口统计学数据、患者解剖特征和围手术期并发症。对于在手术室与重症监护病房接受气管切开术的患者，在年龄、性别、入院原因、气管切开术指征、急性生理与慢性健康状况评估II评分、插管天数或手术所需时间方面，没有统计学上的显著差异。
与环状软骨不可触及的患者相比，环状软骨可触及的患者围手术期并发症发生率显著降低（2%对22%，P<0.001）。两组之间的颈围、颏胸距离和甲状软骨切迹至胸骨距离比较无显著差异，也未进一步明确选择标准。
本研究前瞻性证实了在适当选择的患者中进行床旁气管切开术的安全性。确定了床旁和手术室开放式手术气管切开术的并发症发生率。环状软骨的可触及性作为床旁气管切开术的选择标准具有重要价值。
这些发现将有助于制定危重病患者手术气道管理的方案和路径，以实现成本效益高、质量优的护理。
