Veelo D P, Dongelmans D A, Phoa K N, Spronk P E, Schultz M J
Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam.
Acta Anaesthesiol Scand. 2007 Oct;51(9):1231-6. doi: 10.1111/j.1399-6576.2007.01430.x.
Several factors may delay tracheostomy. As many critically ill patients either suffer from coagulation abnormalities or are being treated with anticoagulants, fear of bleeding complications during the procedure may also delay tracheostomy. It is unknown whether such (usually mild) coagulation abnormalities are corrected first and to what extent. The purpose of this study was to ascertain current practice of tracheostomy in the Netherlands with regard to timing, pre-operative correction of coagulation disorders and peri-/intra-operative measures.
In October 2005, a questionnaire was sent to the medical directors of all non-pediatric ICUs with >/=5 beds suitable for mechanical ventilation in the Netherlands.
A response was obtained from 44 (64%) out of 69 ICUs included in the survey. Seventy-five percent of patients receive tracheostomy within 2 days after the decision to proceed with a tracheostomy. Reasons indicated as frequent causes for delay were most often logistical factors. A heterogeneous attitude exists regarding values of coagulation parameters acceptable to perform tracheostomy. Fifty percent of the respondents have no guideline on correction of coagulation disorders or anticoagulant therapy before tracheostomy. Antimicrobial prophylaxis is almost never administered before tracheostomy. Forty-eight percent mentioned always using endoscopic guidance and 66% of ICUs only perform chest radiography on indication.
There is a high variation in peri- and intra-operative practice of tracheostomy in the Netherlands. Especially on the subject of coagulation and tracheostomy there are different opinions and protocols are often lacking.
多种因素可能会延迟气管切开术。由于许多重症患者存在凝血异常或正在接受抗凝治疗，因此对手术过程中出血并发症的担忧也可能会延迟气管切开术。目前尚不清楚此类（通常较为轻微）的凝血异常是否首先得到纠正以及纠正的程度如何。本研究的目的是确定荷兰目前气管切开术在时机选择、凝血障碍的术前纠正以及围手术期/手术中的措施方面的实际情况。
2005年10月，向荷兰所有拥有≥5张适合机械通气床位的非儿科重症监护病房的医疗主任发送了一份调查问卷。
在纳入调查的69个重症监护病房中，有44个（64%）回复了问卷。75%的患者在决定进行气管切开术后2天内接受了气管切开术。被指出经常导致延迟的原因大多是后勤因素。对于进行气管切开术可接受的凝血参数值存在不同的态度。50%的受访者在气管切开术前没有关于凝血障碍纠正或抗凝治疗的指南。气管切开术前几乎从不进行抗菌预防。48%的受访者提到总是使用内镜引导，66%的重症监护病房仅根据指征进行胸部X线检查。
荷兰气管切开术的围手术期和手术中的实际操作存在很大差异。特别是在凝血和气管切开术这一问题上，存在不同意见且往往缺乏相关方案。
