Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Penn State Hershey Medical Center, Penn State University School of Medicine, 500 University Drive, MCH091, Hershey, PA 17033-0850, USA.
Eur Arch Otorhinolaryngol. 2011 Mar;268(3):415-8. doi: 10.1007/s00405-010-1406-9. Epub 2010 Oct 26.
Tracheotomy is one of the most common surgical procedures performed in the ICU setting. Traditionally tracheotomy has been performed by otolaryngologists as well as general surgeons. While percutaneous tracheotomy (PT) has been available for some time, it has only recently gained widespread acceptance with the advent of convenient and safe kits. Over the past decade, there has been increased utilization of this technique. However, there is a relative reluctance of certain surgical specialties to perform and train residents in PT; a previous study identified that only 29% of otolaryngology head and neck surgery (OTO-HNS) departments in the USA perform PT. In this study we aim to investigate the trends of PT usage in general surgery training programs and compare them to those previously described in otolaryngology programs. The study design is multi-institution physician survey and the study method was a survey of 250 general surgery program directors. This survey was identical to a published survey of OTO-HNS and a head-to-head comparison of results was performed. The response rate was 53% (133 programs). 89% of general surgery programs performed open tracheotomy on a regular basis. 75% performed percutaneous tracheotomy on a regular basis. 79% use the Ciaglia Blue Rhino method. Simultaneous video bronchoscopy was used by 67%. 83% of general surgery residency programs train their residents in PT. 61% felt that PT was either safer than or equal to open tracheotomy. PT is performed in a majority of general surgery residency programs and taught to their trainees. This is in contrast to otolaryngology residency programs, which have been shown to prefer open tracheotomies in both practice and teaching. This trend may severely impact the skills of the next generation of otolaryngologists.
气管切开术是 ICU 中最常见的手术之一。传统上，耳鼻喉科医生和普通外科医生都可以进行气管切开术。虽然经皮气管切开术 (PT) 已经存在一段时间了，但随着方便、安全的套件的出现，它才最近得到广泛认可。在过去的十年中，这种技术的应用有所增加。然而，某些外科专业对进行和培训居民进行 PT 存在一定的抵触情绪；之前的一项研究表明，美国只有 29%的耳鼻喉头颈外科 (OTO-HNS) 部门进行 PT。在这项研究中，我们旨在调查普通外科培训计划中 PT 使用的趋势，并将其与之前在耳鼻喉科计划中描述的趋势进行比较。研究设计是多机构医生调查，研究方法是对 250 名普通外科项目主任进行调查。这项调查与之前对 OTO-HNS 的调查相同，并对结果进行了直接比较。回复率为 53%（133 个项目）。89%的普通外科项目定期进行开放性气管切开术。75%定期进行经皮气管切开术。79%使用 Ciaglia Blue Rhino 方法。67%同时使用视频支气管镜。83%的普通外科住院医师培训计划培训他们的住院医师进行 PT。61%的人认为 PT 比开放性气管切开术更安全或同等安全。PT 在大多数普通外科住院医师培训计划中进行，并教授给他们的学员。这与耳鼻喉科住院医师培训计划形成鲜明对比，后者在实践和教学中都倾向于开放性气管切开术。这种趋势可能会严重影响下一代耳鼻喉科医生的技能。
