Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Crit Care. 2017 Dec 29;21(1):330. doi: 10.1186/s13054-017-1901-0.
Percutaneous dilatational tracheostomy (PDT) in critically ill patients often involves bronchoscopic optical guidance. However, this procedure is not without disadvantages. Therefore, we aimed to study a recently introduced endotracheal tube-mounted camera (VivaSight-SL tube [VST]; ETView, Misgav, Israel) for guiding PDT.
This was a randomized controlled trial involving 46 critically ill patients who received PDT using optical guidance with a VST or with bronchoscopy. The primary outcome measure was visualization of the tracheal structures (i.e., identification and monitoring of the thyroid, cricoid, and tracheal cartilage and the posterior wall) rated on 4-point Likert scales. Secondary measures were the quality of ventilation (before puncture and during the tracheostomy procedure rated on 4-point Likert scales) and blood gases sampled at standardized time points.
The mean ratings for visualization (lower values better; values given for per-protocol analysis) were 5.4 (95% CI 4.5-6.3) for the VST group and 4.0 (95% CI 4.0-4.0) for the bronchoscopy group (p < 0.001). Mean ventilation ratings were 2.5 (95% CI 2.1-2.9) for VST and 5.0 (95% CI 4.4-5.7) for bronchoscopy (p < 0.001). Arterial carbon dioxide increased to 5.9 (95% CI 5.4-6.5) kPa in the VST group vs. 8.3 (95% CI 7.2-9.5) kPa in the bronchoscopy group (p < 0.001), and pH decreased to 7.40 (95% CI 7.36-7.43) in the VST group vs. 7.26 (95% CI 7.22-7.30) in the bronchoscopy group (p < 0.001), at the end of the intervention.
Visualization of PDT with the VST is not noninferior to guidance by bronchoscopy. Ventilation is superior with less hypercarbia with the VST. Because visualization is not a prerequisite for PDT, patients requiring stable ventilation with normocarbia may benefit from PDT with the VST.
ClinicalTrials.gov, NCT02861001 . Registered on 13 June 2016.
在危重症患者中进行经皮扩张气管切开术（PDT）时，常需要支气管镜光学引导。然而，该程序并非没有缺点。因此，我们旨在研究一种新引入的用于引导 PDT 的气管内管安装式摄像机（VivaSight-SL 管[VST]；ETView，Misgav，以色列）。
这是一项随机对照试验，共纳入 46 例接受 PDT 的危重症患者，分别使用 VST 或支气管镜进行光学引导。主要结局测量指标为气管结构的可视化评分（即甲状腺、环状软骨和气管软骨以及后壁的识别和监测，采用 4 分 Likert 量表评分）。次要测量指标为通气质量评分（穿刺前和气管切开过程中的评分，采用 4 分 Likert 量表评分）以及在标准化时间点采集的血气值。
VST 组的平均可视化评分（较低的值更好；基于方案分析的数值）为 5.4（95%CI 4.5-6.3），而支气管镜组为 4.0（95%CI 4.0-4.0）（p<0.001）。VST 组的平均通气评分（95%CI 2.1-2.9）低于支气管镜组（5.0，95%CI 4.4-5.7）（p<0.001）。VST 组的动脉二氧化碳分压升高至 5.9（95%CI 5.4-6.5）kPa，而支气管镜组升高至 8.3（95%CI 7.2-9.5）kPa（p<0.001），VST 组的 pH 值下降至 7.40（95%CI 7.36-7.43），而支气管镜组下降至 7.26（95%CI 7.22-7.30）（p<0.001），在干预结束时。
使用 VST 进行 PDT 的可视化效果并不劣于支气管镜引导。VST 组的通气效果更好，二氧化碳分压升高更少。由于可视化并非 PDT 的前提条件，因此需要稳定通气且二氧化碳分压正常的患者可能受益于 VST 引导的 PDT。
ClinicalTrials.gov，NCT02861001。于 2016 年 6 月 13 日注册。
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