Chandra Ferdinand A, Sedono Rudyanto, Purwamidjaja Dis Bima, Agustin Rita
Anaesthesia and Intensive Care Department, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia.
Clin Med Insights Case Rep. 2023 Apr 12;16:11795476231166241. doi: 10.1177/11795476231166241. eCollection 2023.
Maintaining a patent airway is critical for treating patients with severe inhalation injuries. Percutaneous Dilatational Tracheostomy (PDT) has been used effectively for many patients treated in the Intensive Care Unit (ICU). In addition to its safety for use at the bedside, according to Friedman et al. PDT has the same or even lower complication rate than surgical tracheostomy. PDT can be performed in a shorter time and is more cost-effective. Herein, we report a 44 year old obese woman who sustained an inhalation injury related to a burn. The patient fell headfirst into a pot of boiling water at the time of the burn. The patient showed signs of inhalation injury and suffered a second-to-third degree burn injury. She was treated in the ICU, and early PDT was performed. The procedure was performed by first locating the trachea, followed by a 1-cm incision made between the second and third tracheal ring. She was intubated successfully and treated in the ICU for 7 days. The anesthesiologist chose to perform an early PDT to prevent further complications. This procedure was done successfully despite many comorbidities from the patient, such as being an obese female and having a short neck, which makes finding the exact location for the incision challenging. In this case, the early decision to proceed with PDT showed promising results in decreasing the patient's mortality risk.
维持气道通畅对于治疗重度吸入性损伤患者至关重要。经皮扩张气管切开术（PDT）已有效地应用于许多在重症监护病房（ICU）接受治疗的患者。除了在床边使用安全外，根据弗里德曼等人的研究，PDT的并发症发生率与外科气管切开术相同甚至更低。PDT可以在更短的时间内完成，且成本效益更高。在此，我们报告一名44岁的肥胖女性，她因烧伤导致吸入性损伤。烧伤时患者头部先掉进一锅沸水中。患者出现吸入性损伤迹象，并遭受了二度至三度烧伤。她在ICU接受治疗，并进行了早期PDT。该手术首先定位气管，然后在第二和第三气管环之间做一个1厘米的切口。她成功插管并在ICU治疗了7天。麻醉医生选择进行早期PDT以预防进一步的并发症。尽管患者存在许多合并症，如肥胖女性且颈部较短，这使得找到确切的切口位置具有挑战性，但该手术仍成功完成。在这种情况下，早期决定进行PDT在降低患者死亡风险方面显示出了令人鼓舞的结果。
