Alsunaid Sammar, Holden Van K, Kohli Akshay, Diaz Jose, O'Meara Lindsay B
Division of Pulmonary & Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA.
Department of Internal Medicine, Medstar Washington Hospital Center, Georgetown University, Washington, DC, USA.
J Thorac Dis. 2021 Aug;13(8):5297-5313. doi: 10.21037/jtd-2019-ipicu-13.
Percutaneous dilatational tracheostomy (PDT) and percutaneous endoscopic gastrostomy (PEG) tube placements are routine procedures performed in the intensive care units (ICUs). They are performed to facilitate care and promote healing. They also help prevent complications from prolonged endotracheal intubation and malnutrition. In most cases, both are performed simultaneously. Physicians performing them require knowledge of local anatomy, tissue and vascular relationships, along with advance bronchoscopy and endoscopy skills. Although PDTs and PEGs are considered relatively low-risk procedures, operators need to have the knowledge and skill to recognize and prevent adverse outcomes. Current published literature on post-procedural care and stoma wound management was reviewed. Available recommendations for the routine care of tracheostomy and PEG tubes are included in this review. Signs and symptoms of early PDT- and PEG-related complications and their management are discussed in detail. These include hemorrhage, infection, accidental decannulation, tube obstruction, clogging, and dislodgement. Rare, life-threatening complications are also discussed. Multidisciplinary teams are needed for improved patient care, and members should be aware of all pertinent care aspects and potential complications related to PDT and PEG placement. Each institute is strongly encouraged to have detailed protocols to standardize care. This review provides a state-of-the-art guidance on the care of patients with tracheostomies and gastrostomies specifically in the ICU setting.
经皮扩张气管切开术（PDT）和经皮内镜下胃造口术（PEG）置管是重症监护病房（ICU）中常规开展的操作。进行这些操作是为了便于护理并促进愈合。它们还有助于预防因长时间气管插管和营养不良引起的并发症。在大多数情况下，这两种操作会同时进行。实施这些操作的医生需要了解局部解剖结构、组织和血管关系，以及具备先进的支气管镜检查和内镜检查技能。尽管PDT和PEG被认为是相对低风险的操作，但操作人员需要具备识别和预防不良后果的知识和技能。对当前已发表的关于术后护理和造口伤口管理的文献进行了综述。本综述纳入了气管造口管和PEG管常规护理的现有建议。详细讨论了早期与PDT和PEG相关并发症的体征和症状及其管理。这些并发症包括出血、感染、意外拔管、管道阻塞、堵塞和移位。还讨论了罕见的、危及生命的并发症。需要多学科团队来改善患者护理，团队成员应了解与PDT和PEG置管相关的所有相关护理方面和潜在并发症。强烈鼓励每个机构制定详细的方案以规范护理。本综述为特别是在ICU环境下气管造口术和胃造口术患者的护理提供了最新指导。
