Barba C A, Angood P B, Kauder D R, Latenser B, Martin K, McGonigal M D, Phillips G R, Rotondo M F, Schwab C W
Division of Traumatology and Surgical Critical Care, University of Pennsylvania Medical Center, Philadelphia, USA.
Surgery. 1995 Nov;118(5):879-83. doi: 10.1016/s0039-6060(05)80279-x.
We wanted to assess the efficiency of instituting a modified technique of percutaneous tracheostomy (PET) with bronchoscopic guidance.
During a 10-month period 48 consecutive trauma patients requiring tracheostomy were divided between a standard tracheostomy control group (ST) and a PET group. All patients were followed prospectively. The hospital charges were reviewed retrospectively.
Age, gender, body habitus, and principal diagnosis were similar in the 21 ST patients and the 27 PET patients. All STs and 15 of the PETs were performed in the operating room (OR), and the 12 remaining PETs were done in the intensive care unit (ICU). Four patients in the ST group and six in the PET group died. One of these deaths occurred in a patient in the PET group with severe adult respiratory distress syndrome. Procedure time was shorter for PET (16 versus 45 minutes, p < 0.0001). Junior residents performed more PETs than STs (33% versus 10%), and PET was considered "easier" to perform than ST (81% versus 47%). Hospital charges for PET in the ICU were $3400 less per patient compared with ST or PET in the OR.
PET was performed easily and safely in the OR and at the ICU bedside. PET required one-third the time of ST. Bronchoscopic supervision of PET may have contributed to the small number of complications and the educational experience of junior residents. PET in the ICU can reduce hospital charges significantly and avoids transport of patients to the OR. PET is as safe as ST and should be considered the procedure of choice for an ICU patient requiring an elective tracheostomy.
我们想要评估在支气管镜引导下实施改良经皮气管切开术（PET）的效率。
在10个月期间，48例连续需要气管切开术的创伤患者被分为标准气管切开术对照组（ST）和PET组。所有患者均进行前瞻性随访。对医院收费进行回顾性审查。
21例ST组患者和27例PET组患者在年龄、性别、体型和主要诊断方面相似。所有ST手术和15例PET手术在手术室（OR）进行，其余12例PET手术在重症监护病房（ICU）进行。ST组4例患者和PET组6例患者死亡。其中1例死亡发生在PET组1例患有严重成人呼吸窘迫综合征的患者身上。PET的手术时间更短（16分钟对45分钟，p<0.0001）。低年资住院医师实施的PET手术比ST手术更多（33%对10%），并且PET被认为比ST“更容易”实施（81%对47%）。与手术室的ST或PET相比，ICU中PET的每位患者医院收费少3400美元。
PET在手术室和ICU床边均可轻松、安全地实施。PET所需时间仅为ST的三分之一。支气管镜对PET的监督可能有助于减少并发症数量以及低年资住院医师的学习经验。ICU中的PET可显著降低医院收费并避免将患者转运至手术室。PET与ST一样安全，对于需要择期气管切开术的ICU患者应考虑将其作为首选手术方式。
