Kumar Abhijit, Kohli Amit, Kachru Nishtha, Bhadoria Poonam, Wadhawan Sonia, Kumar Deepak
Department of Anaesthesiology and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India.
Department of Anesthesiology and Intensive Care, Maulana Azad Medical College, Delhi, India.
Indian J Crit Care Med. 2021 Nov;25(11):1269-1274. doi: 10.5005/jp-journals-10071-24021.
Percutaneous dilatational tracheostomy (PCDT) using fiber-optic bronchoscope (FOB) is a widely practiced technique, but its availability and cost remain a concern in nations with limited resources. Mini-surgical technique of PCDT incorporating minimal blunt dissection has shown improved results even without the use of FOB. The study is primarily intended to compare these two techniques and establish a safer cost-effective alternative to FOB-guided PCDTs.
This randomized comparative study [registered (CTRI/2018/04/013191)] was conducted on 120 mechanically ventilated patients. In 60 patients, mini-surgical PCDT (group-M) was performed with 2 cm longitudinal skin incision and blunt dissection till pretracheal fascia without FOB guidance using Portex-Ultraperc sets. In remaining 60 patients, PCDT was performed under FOB vision with similar skin incision (without blunt dissection) using Portex-Ultraperc sets (group-F). Two techniques were compared with regard to procedural time and percentage of complications occurred during or after the procedure.
Procedure time [group-M: 6.30 ± 1.28 minutes; group-F: 14.43 ± 1.84 minutes ( <0.001)] and mean blood loss [group-M: 5.33 ± 1.69 mL; group-F: 6.87 ± 3.11 mL ( = 0.001)] was significantly less in group-M. Higher incidence of desaturation [group-M: 16.7%; group-F: 35% ( = 0.022)] was noted in group-F, whereas arrhythmias [group-M: 21.7%; group-F: 6.7% ( = 0.018)] were higher in group-M. There was no statistical difference in incidence of pneumothorax and subcutaneous emphysema. There was no incidence of posterior tracheal wall perforation in any of the patients.
Mini-surgical technique is a faster alternative of FOB-guided PCDT with comparable incidence of complications. It can safely be used in intensive care units (ICUs) where FOB is not available.
CTRI/2018/05/014307.
Clinical Trials Registry of India (CTRI), URL-http://ctri.nic.in.
Kumar A, Kohli A, Kachru N, Bhadoria P, Wadhawan S, Kumar D. Fiber-optic Bronchoscope-guided vs Mini-surgical Technique of Percutaneous Dilatational Tracheostomy in Intensive Care Units. Indian J Crit Care Med 2021;25(11):1269-1274.
使用纤维支气管镜（FOB）的经皮扩张气管切开术（PCDT）是一种广泛应用的技术，但在资源有限的国家，其可用性和成本仍是一个问题。采用最小钝性分离的PCDT微型手术技术即使不使用FOB也显示出了更好的效果。本研究主要旨在比较这两种技术，并建立一种比FOB引导的PCDT更安全且具成本效益的替代方法。
这项随机对照研究[注册号（CTRI/2018/04/013191）]对120例机械通气患者进行。60例患者采用微型手术PCDT（M组），使用Portex-Ultraperc套件在无FOB引导下做2cm纵向皮肤切口并钝性分离至气管前筋膜。其余60例患者使用Portex-Ultraperc套件在FOB直视下做类似皮肤切口（无钝性分离）进行PCDT（F组）。比较两种技术的操作时间以及术中或术后并发症发生率。
M组的操作时间[M组：6.30±1.28分钟；F组：14.43±1.84分钟（<0.001）]和平均失血量[M组：5.33±1.69mL；F组：6.87±3.11mL（=0.001）]显著少于F组。F组出现更高的低氧饱和度发生率[M组：16.7%；F组：35%（=0.022）]，而M组心律失常发生率更高[M组：21.7%；F组：6.7%（=0.018）]。气胸和皮下气肿发生率无统计学差异。所有患者均未发生气管后壁穿孔。
微型手术技术是FOB引导的PCDT的一种更快的替代方法，并发症发生率相当。在没有FOB的重症监护病房（ICU）中可安全使用。
CTRI/2018/05/014307。
印度临床试验注册中心（CTRI），网址-http://ctri.nic.in。
Kumar A, Kohli A, Kachru N, Bhadoria P, Wadhawan S, Kumar D. 重症监护病房中纤维支气管镜引导与经皮扩张气管切开术的微型手术技术对比。《印度重症医学杂志》2021；25(11):1269 - 1274。
