Shen Luke Y, Helmer Stephen D, Tran Minh T, Nold R Joseph, Thomas Bruce W, Vasquez Donald G
Department of Surgery, The University of Kansas School of Medicine-Wichita, Room 3082, 929 N. Saint Francis St, Wichita, KS 67214, USA.
Am J Surg. 2007 Sep;194(3):409-12. doi: 10.1016/j.amjsurg.2006.10.036.
Complications of percutaneous tracheostomy include bleeding, loss of airway control, inadvertent injury to surrounding structures, and equipment damage, all of which can be attributed to poor visualization and inaccurate orientation. Initially, we performed percutaneous tracheostomy in the intensive care unit setting using the single-dilator technique with video bronchoscopy without external transillumination. During our first 30 procedures, the video bronchoscope was damaged in four instances, requiring costly repairs each time. To decrease the potential for uncertainty, loss of airway control, and equipment damage, the investigators developed a technique incorporating an external laser light source to transilluminate the trachea to accurately identify the correct and appropriate orientation. Since integration of the external transillumination technique, no additional video bronchoscopes have been damaged in 100 subsequent procedures. We conclude transillumination using an external laser light source is useful in identifying the tracheostomy insertion site. This tool decreases instrument damage and improves surgeon confidence during percutaneous tracheostomy placement.
经皮气管切开术的并发症包括出血、气道控制丧失、周围结构的意外损伤以及设备损坏，所有这些都可归因于视野不佳和定位不准确。最初，我们在重症监护病房环境中使用单扩张器技术并结合视频支气管镜进行经皮气管切开术，不使用外部透照法。在我们最初的30例手术中，视频支气管镜有4次受损，每次都需要进行昂贵的维修。为了降低不确定性、气道控制丧失和设备损坏的可能性，研究人员开发了一种技术，该技术结合了外部激光光源对气管进行透照，以准确识别正确且合适的定位。自采用外部透照技术以来，在随后的100例手术中没有额外的视频支气管镜受损。我们得出结论，使用外部激光光源进行透照有助于识别气管切开术的插入部位。该工具可减少器械损坏，并在经皮气管切开术放置过程中提高外科医生的信心。
