Sheu Chau-Chyun, Tsai Jong-Rung, Hung Jen-Yu, Cheng Meng-Hsuan, Chong Inn-Wen, Hwang Jhi-Jhu, Huang Ming-Shyan
Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
Eur J Cardiothorac Surg. 2007 Jan;31(1):114-9. doi: 10.1016/j.ejcts.2006.10.006. Epub 2006 Oct 25.
The potential difficulty in doing initial dilation in the percutaneous dilational tracheostomy (PDT) with the Ciaglia Blue Rhino (CBR) technique has been reported by others and encountered in our clinical practice. To resolve this problem, we developed a modified CBR technique by using a guidewire dilating forceps (GWDF) to facilitate initial dilation. The present before-and-after comparison study aimed to evaluate the clinical benefits of this modified CBR technique.
Consecutive 120 patients undergoing CBR technique in the pre-conversion year and 114 patients undergoing GWDF-CBR technique in the post-conversion year were enrolled for analysis. The procedure time and procedure-related complications were compared between these two groups.
The mean procedure time with GWDF-CBR technique was 4.5+/-1.6min, significantly shorter than 5.7+/-3.0min with CBR technique (p<0.001). Only two patients in the GWDF-CBR group required prolonged procedure time (>8min), compared with 14 patients in the CBR group. Thirty three (27.5%) of 120 patients undergoing CBR technique and 15 (13.1%) of 114 patients undergoing GWDF-CBR technique had PDT-related complications (p=0.006). Most of the complications were minor and transient. Only 13 patients in the CBR group and 3 patients in the GWDF-CBR group encountered major complications (10.8% vs 2.6%, p=0.012). Regarding the high-risk patients, 21 (36.2%) of 58 patients in the CBR group and 9 (15.8%) of 57 patients in the GWDF-CBR group had PDT-related complications (p=0.011).
Pre-dilation with a GWDF in the CBR technique helped to prevent prolonged procedure time and procedure-related complications. We suggest that the bronchoscopy-guided GWDF-CBR serves an easy-to-operate and relatively safe PDT technique for critically ill patients.
其他人已报道并在我们的临床实践中遇到，使用Ciaglia蓝犀牛（CBR）技术进行经皮扩张气管切开术（PDT）时，初始扩张可能存在困难。为解决这一问题，我们通过使用导丝扩张钳（GWDF）来促进初始扩张，开发了一种改良的CBR技术。本前后对照研究旨在评估这种改良CBR技术的临床益处。
纳入转换前一年接受CBR技术的连续120例患者和转换后一年接受GWDF-CBR技术的114例患者进行分析。比较两组的手术时间和与手术相关的并发症。
GWDF-CBR技术的平均手术时间为4.5±1.6分钟，明显短于CBR技术的5.7±3.0分钟（p<0.001）。GWDF-CBR组只有2例患者需要延长手术时间（>8分钟），而CBR组有14例患者。120例接受CBR技术的患者中有33例（27.5%）和114例接受GWDF-CBR技术的患者中有15例（13.1%）发生了与PDT相关的并发症（p=0.006）。大多数并发症为轻微且短暂的。CBR组只有13例患者，GWDF-CBR组只有3例患者发生了严重并发症（10.8%对2.6%，p=0.012）。对于高危患者，CBR组58例患者中有21例（36.2%），GWDF-CBR组57例患者中有9例（15.8%）发生了与PDT相关的并发症（p=0.011）。
在CBR技术中使用GWDF进行预扩张有助于防止手术时间延长和与手术相关的并发症。我们建议，支气管镜引导下的GWDF-CBR是一种易于操作且相对安全的用于重症患者的PDT技术。
