Kolias S, Castana O, Kyriakopoulou M, Rempelos G, Anagiotos G, Alexakis D, Roussos C
Department of Critical Care.
Ann Burns Fire Disasters. 2009 Sep 30;22(3):152-4.
Airway inaccessibility is one of the most dreaded situations in emergency medicine. Surgical tracheostomy is not indicated in emergency situations because it takes a long time and can result in death if respiratory support cannot be provided during the procedure. Emergency percutaneous tracheostomy (PCT) was widely regarded as absolutely counterindicated. Recently, however, a number of studies have appeared on the safety and feasibility of PCT in situations regarded as presenting relative contraindications. We describe the life-saving action of Griggs' PCT in a patient with upper airway obstruction resulting from burns, smoke injuries, and unsuccessful tracheal intubation attempts. Emergency PCT using the Griggs technique was immediately performed without aseptic care, and a 9-mm internal diameter tracheostomy tube was successfully inserted in less than one minute. Griggs' PCT is a quick technique that secures an airway when tracheal intubation fails. The feasibility - in selected cases - of using an emergency Griggs' PCT, in experienced hands, rather than cricothyroidotomy or surgical tracheostomy, is recommended.
气道难以接近是急诊医学中最可怕的情况之一。紧急情况下不建议进行外科气管切开术，因为这需要很长时间，而且如果在手术过程中无法提供呼吸支持，可能会导致死亡。紧急经皮气管切开术（PCT）曾被广泛认为是绝对禁忌的。然而，最近有一些研究探讨了在存在相对禁忌证的情况下PCT的安全性和可行性。我们描述了Griggs经皮气管切开术在一名因烧伤、烟雾损伤导致上气道阻塞且气管插管尝试失败的患者中的救命作用。在未进行无菌护理的情况下立即采用Griggs技术进行了紧急经皮气管切开术，并在不到一分钟的时间内成功插入了内径为9毫米的气管切开管。Griggs经皮气管切开术是一种快速技术，当气管插管失败时可确保气道通畅。对于有经验的人员，在某些特定情况下，建议使用紧急Griggs经皮气管切开术，而不是环甲膜切开术或外科气管切开术。
