Naushad Omar, Bashir M, Rathee Sonal
Anesthesiology and Intensive Care, Subharti Medical College, Meerut U.P. 250005, India.
Department of Clinical Biochemistry, Subharti Medical College Meerut U.P. 250005, India.
Maedica (Bucur). 2022 Mar;17(1):64-73. doi: 10.26574/maedica.2022.17.1.64.
Percutaneous dilational tracheostomy (PDT) is a frequently performed procedure in critically ill patients in hospital emergency department, intensive care unit (ICU) and operating theater (OT). The purpose of this study is to describe a technical modification of Griggs percutaneous tracheostomy by using two 7G and 12G dilators after undergoing sterilization by ethylene oxide. Two hundred patients underwent the procedure. There were no major complications related to the procedure. There were two minor bleedings managed conservatively. The technical modification described in this study is safe and simple to execute and is most cost effective. Patients admitted to ICUs on prolonged mechanical ventilation who are difficult to wean and ventilate, those with facial trauma, oropharyngeal cancer patients, burn patients, a child with diphtheria, patients with chronic obstructive pulmonary disease requiring tracheostomy were included in our retrospective study. The study group underwent PDT using the Naushad's modified Griggs technique. The time taken to perform the procedure, its ease of insertion, number of attempts and its early and late procedural complications were recorded. The time taken by tracheostomy was 3-10 minutes. Our method is most cost effective, as it costs only around 1000 INR/15$, while the whole set of Griggs technique costs around 15000 INR/150 US $. There was only one post procedural infection, no long-term morbidity and a single case got converted to surgical tracheostomy. The technique seems reliable for carrying out percutaneous PDT at bedside in all patients admitted to different hospital departments, including ICUs, triage, emergency and routine OT, as a measure to secure the airway by mainly involving the oral and neck area.
经皮扩张气管切开术(PDT)是医院急诊科、重症监护病房(ICU)和手术室(OT)中危重症患者经常进行的一项操作。本研究的目的是描述一种对Griggs经皮气管切开术的技术改良,即在环氧乙烷灭菌后使用两个7G和12G扩张器。200例患者接受了该手术。没有与手术相关的重大并发症。有两例轻微出血经保守处理。本研究中描述的技术改良操作安全、简单且成本效益最高。纳入我们回顾性研究的患者包括在ICU接受长时间机械通气且难以撤机和通气的患者、面部创伤患者、口咽癌患者、烧伤患者、一名白喉患儿、需要气管切开术的慢性阻塞性肺疾病患者。研究组采用Naushad改良的Griggs技术进行PDT。记录手术所需时间、插入的难易程度、尝试次数以及早期和晚期手术并发症。气管切开术所需时间为3 - 10分钟。我们的方法成本效益最高,因为其成本仅约1000印度卢比/15美元,而整套Griggs技术成本约为15000印度卢比/150美元。术后仅发生一例感染,无长期发病率,且仅有一例转为外科气管切开术。该技术似乎可靠,可在包括ICU、分诊处、急诊科和常规手术室在内的不同医院科室的所有床边患者中进行经皮PDT,作为一种主要通过涉及口腔和颈部区域来确保气道安全的措施。