Cobean R, Beals M, Moss C, Bredenberg C E
Department of Surgery, Maine Medical Center, Portland, USA.
Arch Surg. 1996 Mar;131(3):265-71. doi: 10.1001/archsurg.1996.01430150043008.
To evaluate the safety and cost-effectiveness of percutaneous dilatational tracheostomy performed in the intensive care unit.
Retrospective review of 65 patients with cost-effectiveness analysis.
University-affiliated tertiary care teaching hospital with a 34-bed combined medical-surgical intensive care unit.
All patients who underwent percutaneous dilatational tracheostomy under the supervision of a single general surgeon during a 19-month period. Cost analysis was based on comparison with standard operative tracheostomies performed during the same period.
Percutaneous dilatational tracheostomy was completed in all patients in whom it was attempted, regardless of airway anatomy, body habitus, and ventilator settings. The mean duration of the procedure performed in the intensive care unit was 13.6 minutes (95% confidence interval, 11.7 to 15.5 minutes). Intraoperative complications occurred in 14 patients (22%), most of which were minor technical difficulties, and none resulted in serious morbidity. Postoperative complications occurred in six patients (9%), including one death secondary to premature decannulation, three bleeding complications, one episode of subcutaneous emphysema, and one air leak. Two long-term airway complications after percutaneous dilatational tracheostomy were documented during a mean 7.5-month follow-up of 28 patients. Mean patient charges for the procedure performed in the intensive care unit by a surgeon, nurse, and respiratory therapist were $997 (95% confidence interval, $975 to $1018) compared with $2642 (95% confidence interval, $2513 to $2772) for standard tracheostomy (P<.001). This represented a savings of $1645 (95% confidence interval, $1492 to $1798) per tracheostomy.
Percutaneous dilatational tracheostomy is a safe, rapid, cost-effective alternative to standard open tracheostomy. It can be performed at the bedside, obviating the need to transport critically ill patients from their optimal intensive care unit environment.
评估在重症监护病房进行经皮扩张气管切开术的安全性和成本效益。
对65例患者进行回顾性研究并进行成本效益分析。
一所大学附属的三级护理教学医院，拥有一个34张床位的内外科综合重症监护病房。
在19个月期间，所有在一名普通外科医生监督下接受经皮扩张气管切开术的患者。成本分析基于与同期进行的标准手术气管切开术的比较。
所有尝试进行经皮扩张气管切开术的患者均成功完成手术，无论气道解剖结构、身体状况和呼吸机设置如何。在重症监护病房进行该手术的平均时长为13.6分钟（95%置信区间为11.7至15.5分钟）。14例患者（22%）出现术中并发症，多数为轻微技术问题，无严重并发症发生。6例患者（9%）出现术后并发症，包括1例因过早拔管导致的死亡、3例出血并发症、1例皮下气肿和1例漏气。在对28例患者平均7.5个月的随访中，记录到2例经皮扩张气管切开术后的长期气道并发症。外科医生、护士和呼吸治疗师在重症监护病房进行该手术的平均患者费用为997美元（95%置信区间为975至1018美元），而标准气管切开术的费用为2642美元（95%置信区间为2513至2772美元）（P<0.001）。这意味着每例气管切开术节省1645美元（95%置信区间为1492至1798美元）。
经皮扩张气管切开术是标准开放性气管切开术的一种安全、快速且具有成本效益的替代方法。它可在床边进行，无需将重症患者从最佳的重症监护病房环境中转运出去。
