| Popis: |
Percutaneous dilatational tracheostomy (PDT) is performed routinely in critically ill patients and it is considered a superior alternative to the surgical approach because of the low complication rate, easy bedside insertion, and cost-effectiveness. The ideal timing of tracheostomy is still a subject of debate as there is no clear evidence that early tracheostomy improves relevant endpoints, such as duration of mechanical ventilation, length of intensive care unit (ICU) stay, and mortality. A number of authors have recommended the use of bronchoscopy during PDT because it allows direct visualization of the airway during tracheostomy placement. When the bronchoscope was used, positioning of the endotracheal tube, the placement of the needle into the trachea, the actual dilatation of the tracheostomy site, and the final placement of the tracheostomy tube were done under direct visualization. Some authors suggest that the use of bronchoscopic guidance during tracheostomy is not routinely required but may be used as an important adjunct in selected patients, such as those with HALO cervical fixation, obesity, or difficult anatomy. In addition, several authors have reported significant hypercarbia related to impared ventilation because of bronchoscopy use during tracheostomy. In our institution we perform bronchoscopy-guided percutaneous tracheostomy. Sixty-five patients underwent PDT placement for prolonged mechanical ventilation, all with the assistance of a bronchoscope. There were fifty - one men and 14 women with a mean age of 61 ± 38 years. The indication for tracheostomy was respiratory failure from a variety of medical and surgical causes. In first ten patients we perform dilatation with a specific forceps technique, and all other single-step dilatation with single tapered dilatators. All PDT were performed without incident. Absence of complications was due to careful screening and selection of patients and being performed or supervised by an experienced intensivist under direct vision. Bronchoscopy-guided percutaneous tracheostomy is a safe alternative for conventional tracheostomy when performed in ICU by personnel with expertise and appropriate training. Bronchoscopy helps to reduce the risk of major complications and aids in the management of minor complications. With regard to the different percutaneous techniques available today, based on our experience, we prefer the single-step dilatation (Chiaglia Blue Rhino) technique. |
