Madero Pérez J, Vidal Tegedor B, Abizanda Campos R, Cubedo Bort M, Alvaro Sánchez R, Micó Gómez M
Servicio de Medicina Intensiva, Hospital Universitario Asociado General de Castellón, Castellón, España.
Med Intensiva. 2007 Apr;31(3):120-5. doi: 10.1016/s0210-5691(07)74789-7.
Percutaneous tracheostomy is an alternative to conventional surgical tracheostomy. It is associated to a more feasible procedure, that is less invasive and linked to a lower degree of complications. Herein, we review our experience since the implementation of this technique in our Department.
Retrospective observational.
Nineteen-bed intensive care department, in a general reference teaching hospital.
A total of 115 of 130 tracheostomies performed from 2001 to 2003 were retrospectively analyzed. Collected data include epidemiological information, reason for performing the procedure, maintenance time of artificial airway before the tracheostomy and type of ventilatory support or oxygen supplementation before and after the procedure. The modified PEEP (PEEP-mod = FiO2 x PEEP) was calculated, sedation level received before and 4-6 hours after the technique and also 24 hours later, were reviewed. Subsequent patient evolution was collected.
Observational study on the results of routine procedures.
Blood gases indicators of effectiveness in oxygen supply and the need of mechanical ventilation support.
Median age of the 115 reviewed patients was 65 years. The most common admission reasons were: brain vascular accident in 25 cases, head and neck injury in 21, cancer in 11 and sepsis in 10 patients. Tracheostomy was indicated because prolonged mechanical ventilation in 52 patients, coma in 28 and emergency or scheduled surgery in 10 cases. Median length of stay in the ICU before tracheostomy was 14 days. Ninety-two patients were discharged from the ICU, and 52 from the Hospital. The remaining patients died during their hospital stay. Serious complications appeared in 5 patients (4%); 3 of them were the development of fistulae and all of them occurred in patients in whom the tracheostomy was performed in the ICU at bedside. Before the procedure, 72 patients were under mechanical ventilation, but only 56 received ventilatory support 24 hours after tracheostomy. When PEEP-mod values were analyzed, first monitoring of median value was 1.6 (range 0 to 2), 4-6 hours time median value was 2 (1.4-2.45), and 24 hours later median value was 1.2 (0-2) (global variation, p < 0.001).
In our experience, percutaneous tracheostomy performed at bedside in the ICU is an adequate solution with a low complication rate and its makes it possible to reduce the level of ventilatory support.
经皮气管切开术是传统外科气管切开术的一种替代方法。它是一种更可行的手术，侵入性较小，并发症发生率较低。在此，我们回顾了自该技术在我们科室实施以来的经验。
回顾性观察研究。
一家综合参考教学医院的19张床位的重症监护病房。
对2001年至2003年期间进行的130例气管切开术中的115例进行回顾性分析。收集的数据包括流行病学信息、手术原因、气管切开术前人工气道的维持时间以及手术前后的通气支持类型或氧疗情况。计算改良呼气末正压（PEEP-mod = FiO2×PEEP），回顾手术前、术后4 - 6小时以及24小时后的镇静水平。收集患者随后的病情进展情况。
对常规手术结果进行观察性研究。
氧供应有效性的血气指标以及机械通气支持的需求。
115例回顾患者的中位年龄为65岁。最常见的入院原因是：25例脑血管意外，21例头颈部损伤，11例癌症，10例脓毒症。气管切开术的指征为：52例因机械通气时间延长，28例因昏迷，10例因急诊或择期手术。气管切开术前在重症监护病房的中位住院时间为14天。92例患者从重症监护病房出院，52例从医院出院。其余患者在住院期间死亡。5例患者（4%）出现严重并发症；其中有3例发生瘘管，且均发生在在重症监护病房床边进行气管切开术的患者中。手术前，72例患者接受机械通气，但气管切开术后24小时仅有56例接受通气支持。分析PEEP-mod值时，首次监测的中位值为1.6（范围0至2），4 - 6小时时的中位值为2（1.4 - 2.45），24小时后的中位值为1.2（0 - 2）（总体差异，p < 0.001）。
根据我们的经验，在重症监护病房床边进行经皮气管切开术是一种合适的解决方案，并发症发生率低，并且能够降低通气支持水平。
