Laisaar Tanel, Jakobson Eero, Sarana Bruno, Sarapuu Silver, Vahtramäe Jüri, Raag Mait
Department of Thoracic Surgery, Lung Clinic, Tartu University Hospital, Tartu, Estonia.
Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia.
SAGE Open Med. 2016 Sep 21;4:2050312116670407. doi: 10.1177/2050312116670407. eCollection 2016.
Percutaneous tracheostomy is a common procedure but varies considerably in approach. The aim of our study was to evaluate the need for intraoperative bronchoscopy and to compare various surgical techniques.
During 1 year all percutaneous tracheostomies in three intensive care units were prospectively documented according to a unified protocol. In one unit, bronchoscopy was used routinely and in others only during the study.
A total of 111 subjects (77 males) with median age 64 (range, 18-86) years and body mass index 25.4 (range, 15.9-50.7) were included. In unit A, tracheal wall was directly exposed; in unit B, limited dissection to enable tracheal palpation was made. In both units, bronchoscopy was used to check the location of an already inserted guiding needle; needle position required correction in 8% and 12% of cases, respectively. In unit C, in tracheostomies without pretracheal tissue dissection, bronchoscopy was used to guide needle insertion; needle position required correction in 66% of cases. Median duration of operations performed by thoracic surgeons and residents was 10 (range, 3-37) min and by intensive care doctors and residents was 16.5 (range, 3-63) min (p < 0.001). Time from the beginning of preparations for tracheostomy until the end of the whole procedure was median 32 min for bedside tracheostomies and 64 min for operations in the operating theatre (p < 0.001).
Limited pretracheal tissue dissection enabled proper guiding needle insertion and bronchoscopy was rarely needed. Percutaneous tracheostomies performed by thoracic surgeons took less time, and duration of the whole procedure was remarkably shorter when performed at bedside.
经皮气管切开术是一种常见的操作，但手术方法差异很大。本研究的目的是评估术中支气管镜检查的必要性，并比较各种手术技术。
在1年的时间里，按照统一方案对三个重症监护病房的所有经皮气管切开术进行前瞻性记录。在一个病房，常规使用支气管镜检查，在其他病房仅在研究期间使用。
共纳入111例受试者（77例男性），中位年龄64岁（范围18 - 86岁），体重指数25.4（范围15.9 - 50.7）。在A病房，直接暴露气管壁；在B病房，进行有限的解剖以能够触诊气管。在这两个病房，均使用支气管镜检查已插入的引导针的位置；针位置分别在8%和12%的病例中需要校正。在C病房，在未进行气管前组织解剖的气管切开术中，使用支气管镜引导针插入；针位置在66%的病例中需要校正。胸外科医生和住院医师进行手术的中位持续时间为10分钟（范围3 - 37分钟），重症监护医生和住院医师为16.5分钟（范围3 - 63分钟）（p < 0.001）。从气管切开术准备开始到整个手术结束的时间，床边气管切开术的中位时间为32分钟，手术室手术为64分钟（p < 0.001）。
有限的气管前组织解剖能够正确插入引导针，很少需要支气管镜检查。胸外科医生进行的经皮气管切开术耗时较少，在床边进行时整个手术的持续时间明显更短。
