Marelli D, Paul A, Manolidis S, Walsh G, Odim J N, Burdon T A, Shennib H, Vestweber K H, Fleiszer D M, Mulder D S
McGill University, Montreal General Hospital Critical Care & Trauma Unit, Canada.
J Trauma. 1990 Apr;30(4):433-5.
Percutaneous tracheostomy is increasingly being used for patients needing prolonged ventilatory support. The purpose of this study was to assess the feasibility of widespread application of endoscopic guided percutaneous tracheostomy. Sixty-one consecutive ICU patients requiring prolonged mechanical ventilation underwent bedside endoscopic guided percutaneous tracheostomy. Using a modified Ciaglia technique, a #6-10 tracheostomy tube was introduced between the second and third tracheal rings. Bronchoscopic transillumination facilitated identification of the appropriate tracheostomy site, and verified satisfactory placement of dilators and tracheostomy tube. There was one procedure-related death due to arrhythmia. Procedure-related complications included (n = 7): bleeding (controlled with local pressure), two infections, two cuff tears, and two obstructions of the tracheal tube. The tracheostomy was eventually removed in 13 patients. Bronchoscopic evaluation of three patients at 4 months post-tracheostomy removal was normal and there has been no clinical evidence suggestive of tracheal stenosis in the remaining ten extubated patients. There was a 50% reduction in cost when compared to operative tracheostomy. Percutaneous tracheostomy is a simple, safe, cost-effective bedside procedure for critically ill ventilator-dependent patients. Endoscopic guidance appears to increase the safety of this procedure and may prevent complications of pneumothorax, subcutaneous emphysema, and paratracheal false passage previously reported with blinded percutaneous methods.
经皮气管切开术越来越多地用于需要长期通气支持的患者。本研究的目的是评估内镜引导下经皮气管切开术广泛应用的可行性。61例需要长期机械通气的ICU连续患者接受了床边内镜引导下经皮气管切开术。采用改良的Ciaglia技术，在第二和第三气管环之间插入6-10号气管切开管。支气管镜透照有助于确定合适的气管切开部位，并验证扩张器和气管切开管的满意放置。有1例与手术相关的死亡，原因是心律失常。与手术相关的并发症包括（n = 7）：出血（通过局部压迫控制）、2例感染、2例套管撕裂和2例气管导管阻塞。最终有13例患者拔除了气管切开管。在拔除气管切开管4个月后，对3例患者进行的支气管镜评估正常，其余10例拔管患者没有临床证据提示气管狭窄。与手术气管切开术相比，成本降低了50%。经皮气管切开术对于依赖呼吸机的重症患者是一种简单、安全、经济有效的床边操作。内镜引导似乎提高了该操作安全性，并可能预防先前盲目经皮方法所报道的气胸、皮下气肿和气管旁假道等并发症。
