Kim Ji Eun, Lee Dong Hyun
Department of Emergency Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea.
Department of Intensive Care Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea.
Acute Crit Care. 2022 Feb;37(1):101-107. doi: 10.4266/acc.2021.00906. Epub 2022 Feb 17.
Percutaneous dilatational tracheostomy (PDT) is a common procedure in intensive care units (ICUs). Although it is thought to be safe and easily performed at the bedside, PDT usually requires endotracheal guidance, such as bronchoscopy. Here, we assessed the clinical outcomes and safety of PDT conducted without endotracheal guidance.
In the ICU and coronary ICU at a tertiary hospital, PDT was routinely performed without endotracheal guidance by a single medical intensivist using the Griggs technique PDT kit (Portex Percutaneous Tracheostomy Kit). We retrospectively reviewed the electronic medical records of patients who underwent PDT without endotracheal guidance.
From January 1 to December 31, 2018, 78 patients underwent PDT without endotracheal guidance in the ICU and coronary ICU. The mean age of these subjects was 71.9±11.5 years, and 29 (37.2%) were female. The mean Acute Physiology And Chronic Health Evaluation (APACHE) II score at 24 hours after admission was 25.9±5.8. Fifty patients (64.1%) were on mechanical ventilation during PDT. Failure of the initial PDT attempt occurred in 4 patients (5.1%). In two of them, PDT was aborted and converted to surgical tracheostomy; in the other two patients, PDT was reattempted after endotracheal reintubation, with success. Minor bleeding at the tracheostomy site requiring gauze changes was observed in five patients (6.4%). There were no airway problems requiring therapeutic interventions or procedure-related sequelae.
PDT without endotracheal guidance can be considered safe and feasible.
经皮扩张气管切开术（PDT）是重症监护病房（ICU）的常见操作。尽管人们认为该操作在床边进行安全且易于实施，但PDT通常需要气管内引导，如支气管镜检查。在此，我们评估了在无气管内引导下进行PDT的临床结局和安全性。
在一家三级医院的ICU和冠心病重症监护病房，由一名医学重症专家使用Griggs技术PDT套件（Portex经皮气管切开术套件），在无气管内引导的情况下常规进行PDT。我们回顾性分析了接受无气管内引导PDT患者的电子病历。
2018年1月1日至12月31日，78例患者在ICU和冠心病重症监护病房接受了无气管内引导的PDT。这些受试者的平均年龄为71.9±11.5岁，29例（37.2%）为女性。入院后24小时的平均急性生理与慢性健康状况评分（APACHE）II为25.9±5.8。50例患者（64.1%）在PDT期间接受机械通气。初次PDT尝试失败发生在4例患者（5.1%）中。其中2例放弃PDT并改为外科气管切开术；另外2例患者在重新气管插管后再次尝试PDT并成功。5例患者（6.4%）在气管切开部位出现少量出血，需要更换纱布。未出现需要治疗干预的气道问题或与操作相关的后遗症。
无气管内引导的PDT可被认为是安全可行的。
