Grensemann J, Eichler L, Hopf S, Jarczak D, Simon M, Kluge S
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Respiratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Acta Anaesthesiol Scand. 2017 Jul;61(6):660-667. doi: 10.1111/aas.12904. Epub 2017 May 11.
Percutaneous dilatational tracheostomy (PDT) in critically ill patients is often led by optical guidance with a bronchoscope. This is not without its disadvantages. Therefore, we aimed to study the feasibility of a recently introduced endotracheal tube-mounted camera (VivaSight™-SL, ET View, Misgav, Israel) in the guidance of PDT.
We studied 10 critically ill patients who received PDT with a VivaSight-SL tube that was inserted prior to tracheostomy for optical guidance. Visualization of the tracheal structures (i.e., identification and monitoring of the thyroid, cricoid, and tracheal cartilage and the posterior wall) and the quality of ventilation (before puncture and during the tracheostomy) were rated on four-point Likert scales. Respiratory variables were recorded, and blood gases were sampled before the interventions, before the puncture and before the insertion of the tracheal cannula.
Visualization of the tracheal landmarks was rated as 'very good' or 'good' in all but one case. Monitoring during the puncture and dilatation was also rated as 'very good' or 'good' in all but one. In the cases that were rated 'difficult', the visualization and monitoring of the posterior wall of the trachea were the main concerns. No changes in the respiratory variables or blood gases occurred between the puncture and the insertion of the tracheal cannula.
Percutaneous dilatational tracheostomy with optical guidance from a tube-mounted camera is feasible. Further studies comparing the camera tube with bronchoscopy as the standard approach should be performed.
重症患者的经皮扩张气管切开术（PDT）通常在支气管镜的光学引导下进行。这并非没有缺点。因此，我们旨在研究一种最近推出的气管插管式摄像头（VivaSight™-SL，ET View，以色列米斯加夫）在PDT引导中的可行性。
我们研究了10例接受PDT的重症患者，在气管切开术前插入VivaSight-SL导管以进行光学引导。气管结构的可视化（即甲状腺、环状软骨、气管软骨和后壁的识别与监测）以及通气质量（穿刺前和气管切开期间）采用四点李克特量表进行评分。记录呼吸变量，并在干预前、穿刺前和插入气管套管前采集血气样本。
除1例病例外，所有病例气管标志的可视化均被评为“非常好”或“好”。除1例病例外，穿刺和扩张期间的监测也被评为“非常好”或“好”。在被评为“困难”的病例中，气管后壁的可视化和监测是主要问题。从穿刺到插入气管套管期间，呼吸变量和血气没有变化。
在气管插管式摄像头的光学引导下进行经皮扩张气管切开术是可行的。应进行进一步研究，将带摄像头的导管与作为标准方法的支气管镜检查进行比较。
