Nowak Andreas, Kern Peter, Koscielny Sven, Usichenko Taras I, Hahnenkamp Klaus, Jungehülsing Markus, Tittel Matthias, Oeken Jens, Klemm Eckart
Department of Anesthesiology & Intensive Care Medicine, Emergency Medicine & Pain Management, Dresden Friedrichstadt Hospital, Dresden University Teaching Hospital, Friedrichstrasse 41, 01067, Dresden, Germany.
Department of Otolaryngology and Institute of Phoniatry and Pedaudiology, Jena University Hospital, Jena, Germany.
BMC Anesthesiol. 2017 Jan 14;17(1):7. doi: 10.1186/s12871-017-0301-y.
Fiberoptic tracheo-bronchoscopy is the most commonly used procedure for percutaneous dilational tracheotomy (PDT). However, PDT can be associated with major complications, including death. Furthermore it is unclear, whether the tracheal ring fractures may contribute to the development of tracheal stenosis after PDT nor whether tracheal ring fractures can be prevented by using a rigid endoscope for this procedure. The purpose of this study was to evaluate the feasibility of and the incidence of complications for PDT using the rigid tracheotomy endoscope (TED).
In a prospective multicenter observational study from 2006 to 2010, 180 adult patients in intensive care and those scheduled for ear, nose and throat surgery underwent PDT using TED. Data collection was performed using a structured protocol. The patients were observed according to PDT phase (phase 1: puncture, phase 2: dilatation and phase 3: cannula insertion). The descriptive data are given as the number (percent) of cases and the mean ± standard deviation (SD) where appropriate. The relationships between dichotomous and categorical parameters were analyzed using the chi-square test. P values ≤ 0.05 were considered significant.
PDT was performed in 179 patients. The procedure time was 14.8 ± 6.2 (mean ± SD) minutes. Pneumothorax or procedure-related lethal complications did not occur. Other adverse events included tracheal ring fractures (17.1%), desaturations (6.8%), special incidents (6.2%), bleeding (5.5%), anesthesia complications (4.5%) and posterior tracheal wall injuries (1.1%).
The use of TED in PDT is feasible, and the incidence of complications and adverse events was comparable with that of PDT using the flexible endoscope. Tracheal ring fractures in PDT cannot be avoided by the use of a rigid endoscope. With TED, the airway always remains open thus the use of jet ventilation via the TED during PDT is possible.
纤维支气管镜检查是经皮扩张气管切开术（PDT）最常用的操作方法。然而，PDT可能会引发包括死亡在内的严重并发症。此外，目前尚不清楚气管环骨折是否会导致PDT术后气管狭窄的发生，也不清楚在该操作中使用硬质内镜能否预防气管环骨折。本研究的目的是评估使用硬质气管切开内镜（TED）进行PDT的可行性及并发症发生率。
在一项2006年至2010年的前瞻性多中心观察性研究中，180例重症监护成年患者以及计划接受耳鼻喉手术的患者接受了使用TED的PDT。数据收集采用结构化方案。根据PDT阶段（阶段1：穿刺，阶段2：扩张，阶段3：套管插入）对患者进行观察。描述性数据以病例数（百分比）给出，并在适当情况下给出均值±标准差（SD）。使用卡方检验分析二分法和分类参数之间的关系。P值≤0.05被认为具有统计学意义。
179例患者接受了PDT。手术时间为14.8±6.2（均值±SD）分钟。未发生气胸或与手术相关的致命并发症。其他不良事件包括气管环骨折（17.1%）、血氧饱和度下降（6.8%）、特殊事件（6.2%）、出血（5.5%）、麻醉并发症（4.5%）和气管后壁损伤（1.1%）。
在PDT中使用TED是可行的，并发症和不良事件的发生率与使用柔性内镜进行PDT的情况相当。使用硬质内镜无法避免PDT中的气管环骨折。使用TED时气道始终保持开放，因此在PDT期间通过TED进行喷射通气是可行的。
