Yilmaz Murat, Dosemeci Levent, Cengiz Melike, Sanli Suat, Gajic Ognjen, Ramazanoglu Atilla
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Antalya, Turkey.
Neurocrit Care. 2006;5(2):120-3. doi: 10.1385/ncc:5:2:120.
Percutaneous tracheostomy is a widely used and accepted method for long-term mechanical ventilation and airway protection. Neurocritically ill patients sometimes require repeat tracheostomy, which is traditionally considered a relative contraindication for percutaneous procedure. The aim of this study was to determine the safety of repeat percutaneous tracheostomy in neurocritically ill patients with a history of previous tracheostomy.
In the 16-bed academic neurointensive care unit, we prospectively enrolled patients who needed new tracheostomy placement for airway protection or prolonged mechanical ventilation and had previously undergone percutaneous tracheostomy placement. We collected data on indications, procedure, periprocedural complications, and outcome of repeated tracheostomy.
Between January 2001 and October 2005, we enrolled 12 consecutive patients (mean age 35.4 +/- 7.0 years) who underwent repeat percutaneous tracheostomy. Head injury was the most common underlying diagnosis (seven patients, 58%). Tracheostomy tube placement was easy and successful in all patients, and none of the patients needed conversion to surgical tracheostomy. In three patients, ultrasound-guided needle aspiration was used before the procedure to confirm the position of the trachea. No patients died or experienced serious complication related to the procedure. Two patients (17%) had a minor periprocedural bleeding, which was controlled with local compression. Long-term outcome was poor, with only two patients alive and off the ventilator at hospital discharge, both with serious disability.
Repeat percutaneous tracheostomy can be performed safely in neurocritically ill patients who have undergone previous tracheostomy.
经皮气管切开术是一种广泛应用且被认可的用于长期机械通气和气道保护的方法。神经重症患者有时需要再次气管切开术，传统上这被认为是经皮操作的相对禁忌证。本研究的目的是确定在有既往气管切开术史的神经重症患者中再次经皮气管切开术的安全性。
在拥有16张床位的学术性神经重症监护病房，我们前瞻性地纳入了那些因气道保护或延长机械通气而需要重新进行气管切开术且既往曾接受过经皮气管切开术的患者。我们收集了关于再次气管切开术的适应证、操作过程、围手术期并发症及结果的数据。
在2001年1月至2005年10月期间，我们连续纳入了12例接受再次经皮气管切开术的患者（平均年龄35.4±7.0岁）。头部损伤是最常见的基础诊断（7例患者，占58%）。所有患者的气管切开管置入均轻松且成功，没有患者需要转为外科气管切开术。3例患者在操作前使用超声引导下针吸来确认气管位置。没有患者因该操作死亡或出现严重并发症。2例患者（17%）出现轻微的围手术期出血，通过局部压迫得以控制。长期预后较差，出院时仅有2例患者存活且脱机，均有严重残疾。
在既往接受过气管切开术的神经重症患者中，再次经皮气管切开术可安全进行。
