当前位置： SCI文献检索 > WORLD JOURNAL OF SURGERY期刊下所有文献 > Bedside percutaneous tracheostomy: prospective evaluation of a modification of the current technique in 100 patients.

Bedside percutaneous tracheostomy: prospective evaluation of a modification of the current technique in 100 patients.

Abstract：

:Percutaneous dilatational tracheostomy (PDT) is being increasingly used. Concerns have been raised as to its safety, especially when it is done at the bedside. A prospective evaluation was conducted of 100 consecutive, unselected critically ill patients with PDT. The mean intensive care unit (ICU) stay before PDT was 12 days. One surgeon performed PDT alone (5 cases) or assisted residents (95 cases) in all operations; 84 were performed at the ICU bedside. Only the first six patients were taken to the operating room solely for tracheostomy. A modified technique was used: (1) the endotracheal tube was left in place during sequential dilations; (2) dilators were inserted in a 60-degree cephalad orientation to the skin and directed caudally after penetration of the anterior tracheal wall; (3) a digit was inserted through the tracheal opening to guide withdrawal of the endotracheal tube to the level of the vocal cords; and (4) size 8 tracheostomy cannulas were inserted over 28F dilators. The average time from skin incision to insertion of the tracheostomy tube was 12 minutes (< 10 minutes, 41 patients; 10 to 15 minutes, 37 patients; > 15 minutes, 22 patients). Sixty-five percent had unfavorable anatomic conditions due to spinal precautions or diffuse neck edema. Postoperative complications occurred in four patients; surgical emphysema after tracheal lacerations in three, cannula dislodgment in one. All complications were successfully managed without an operation by tube exchange (n = 3) or observation (n = 1); there was no procedure-related mortality. Forty patients were available for long-term follow-up (6-18 months after tracheostomy) by telephone; one had persistent hoarseness without respiratory difficulty. We concluded that bedside PDT is safe and easy to teach when performed with a technique that ensures correct instrumentation.

journal_name

World J Surg

journal_title

World journal of surgery

authors

Velmahos GC,Gomez H,Boicey CM,Demetriades D

doi

10.1007/s002680010180

keywords:

subject

Has Abstract

pub_date

2000-09-01 00:00:00

pages

1109-15

issue

eissn

0364-2313

issn

1432-2323

journal_volume

pub_type

杂志文章

在线工具

Bedside percutaneous tracheostomy: prospective evaluation of a modification of the current technique in 100 patients.