scholarly journals Percutaneous Dilatational Tracheostomy (PDT) Dini Sebagai Upaya untuk Mencegah Pneumonia dan Mempermudah Perawatan Pasien Stroke di Intensive Care Unit (ICU)

2021 ◽  
Vol 13 (1) ◽  
pp. 31-41
Author(s):  
I Wayan Suryajaya ◽  
Prananda Surya Airlangga ◽  
Eddy Rahardjo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Basal Ganglia ◽  
Glasgow Coma Scale ◽  
Oral Hygiene ◽  
Guide Wire ◽  
Percutaneous Dilatational Tracheostomy ◽  
Ventilator Associated Pneumonia ◽  
Surgical Tracheostomy ◽  
Dilatational Tracheostomy

Latar Belakang: Stroke atau cerebrovasuler accident (CVA) merupakan hilangnya fungsi-fungsi otak dengan cepat akibat terganggunya suplai darah ke otak. Tidak jarang pasien stroke dirawat di intensive care unit (ICU) karena mengalami gagal napas sehingga membutuhkan ventilator. Kemampuan menelan dan refleks batuk yang tidak adekuat pada pasien stroke sering menyebabkan komplikasi pneumonia/ stroke associated pneumonia (SAP). Komplikasi pneumonia bisa juga disebabkan oleh penggunaan ventilator yang sering disebut ventilator associated pneumonia (VAP). SAP maupun VAP pada pasien stroke dapat dicegah dengan tindakan trakeostomi dini. Percutaneous dilatational tracheostomy (PDT) merupakan teknik trakeostomi dengan melakukan sayatan minimal untuk memasukkan guide wire sebagai panduan. Kemudian lubang trakeostomi diperlebar dengan menggunakan multipel dilator sampai canule trakeostomi bisa masuk ke trakea. PDT lebih mudah dilakukan dibanding surgical tracheostomi sehingga lebih menguntungkan dikerjakan untuk pasien kritis di ICU.Kasus: Terdapat 3 kasus pasien stroke yang dilaporkan dengan glasgow coma scale (GCS) dibawah 8. Kasus pertama: Pasien stroke dengan subakut infark di basal ganglia dekstra dan oedema cerebri. GCS E1V2M1 Pasien mengalami sumbatan partial jalan napas. Pasien dirawat di ICU dan diakukan intubasi. PDT dikerjakan hari ke 2 dengan tujuan untuk mengamankan jalan napas dan mempermudah bronchial toilet sehingga dapat mencegah terjadinya pneumonia.Kasus kedua: pasien stroke dengan infark luas di hemisphere kanan. Pasien dirawat di ICU dengan ventilator. PDT dilakukan pada hari ke 8 untuk mempermudah melakukan fisioterapi napas, bronkial/trakeal toilet. Setelah 50 hari pasien dipindahkan ke ruangan tanpa ditemukan pneumonia.Kasus ketiga: Pasien dengan kesadaran menurun GCS E2V1M3. Pasien dirawat di ICU dengan sumbatan partial jalan napas. PDT dilakukan pada hari pertama dengan tujuan mempertahankan jalan napas tetap aman dan mempermudah tracheal/ bronchial toilet. Pasien dirawat selama 110 hari dan pindah ke ruangan.Pembahasan: Pada ketiga kasus tersebut dilakukan usaha tracheostomi/ PDT secara dini dengan tujuan mengamankan jalan napas tetap bebas, memudahkan oral hygiene dan melakukan fisioterapi napas berupa tracheal/ bronchial toilet. Trakeostomi juga memudahkan mobilisasi pasien sehingga merupakan upaya untuk mencegah terjadinya pneumonia selama perawatan. Selama perawatan pasien tersebut di ICU tidak terjadi komplikasi pneumonia sampai pasien keluar dari ICU. Kesimpulan: Pasien stroke dengan GCS dibawah 8 akan mengalami perawatan yang lama dan potensial terjadi komplikasi berupa SAP maupun VAP bila memakai ventilator. Trakeostomi dini selain mempermudah perawatan dan mempercepat weaning juga sebagai upaya untuk mencegah terjadinya pneumonia. PDT merupakan teknik trakeostomi yang cocok dilakukan untuk pasien kritis di ICU karena lebih menguntungkan dibanding surgical tracheostomy.

scholarly journals Fiberoptic bronchoscope guided percutaneous dilatational tracheostomy in intensive care unit: a prospective observational study

2015 ◽  
Vol 2 (2) ◽  
pp. 52-55
Author(s):  
Asfar Azimee ◽  
Taiyenjam Kennedy Singh
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Guide Wire ◽  
Percutaneous Dilatational Tracheostomy ◽  
Prospective Clinical Study ◽  
Fiberoptic Bronchoscope ◽  
Tracheal Mucosa ◽  
Dilatational Tracheostomy ◽  
Weaning Failure ◽  
The Mean

Background: The aim of the study was to evaluate the safety of fiberoptic bronchoscope guided percutaneous dilatational tracheostomy performed in the intensive care unit.Methods: This was a prospective clinical study done on 30 critically ill patients in Intensive care unit. A puncture was made with 16G cannula at the second or third tracheal interspace which was confirmed by the fiberoptic bronchoscope. This was followed by insertion of guide wire through the cannula followed by insertion of the guiding catheter over the guide wire. The tract was enlarged with white single stage dilator to allow placement of a standard tracheostomy tube. The procedure was continuously monitored with the fiberoptic bronchoscope. Complications were noted during procedure and till patient’s stay in Intensive care unit.Results: The study included 18 (60%) male and 12 (40%) female patients. The mean age was 64.5±8 years. Percutaneous dilatational tracheostomy was done early (<10 days) in 10 (33.3%) patients and late (>10 days) in 20 (66.7%) patients. Fentanyl was used for the procedure in all the patients and among them 8 (26.6%) patients required injection rocuronium. Average procedure duration, from incision to suture for 30 patients was 12.6± 2 minutes. Indication for tracheostomy was weaning failure in 22 (73.3%) patients and airway maintenance in 8 (26.6%) patients. The mean duration patient remained on mechanical ventilation was 12.6 days and mean length of stay in critical care unit before shifting to ward was 7.6 days after tracheostomy. Acute postprocedure complications were transient bleed in four patients (13.3%), two (6.7%) had stomal bleeding, one (3%) had tracheal mucosa laceration and another (3%) had subcutaneous emphysema. No cases of stomal infection, pneumothorax, tracheal laceration, paratracheal insertion, pneumothorax and pneumomediastinum. There was no procedure-related mortality. Conclusion: Fiberoptic bronchoscope guided percutaneous dilatational tracheostomy is safe and the method of choice for elective tracheostomy in the majority of intensive care patientsJournal of Society of Anesthesiologists of Nepal 2015; 2(2): 52-55

Comparison of Percutaneous Dilatational Tracheostomy with Open Tracheostomy in Intensive Care Unit

2019 ◽  
Vol 41 (1) ◽  
pp. 1-7
Author(s):  
Pramesh S Shrestha ◽  
Moda N Marhatta ◽  
Subhash P Acharya ◽  
Ninadini Shrestha
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Percutaneous Tracheostomy ◽  
Percutaneous Dilatational Tracheostomy ◽  
Hospital Length Of Stay ◽  
Apache Ii Score ◽  
Time Duration ◽  
Surgical Tracheostomy ◽  
Dilatational Tracheostomy ◽  
Emergency Procedures

Introduction: Tracheostomy is one of the frequent surgical procedure carried out in intensive care unit. Percutaneous tracheostomy is becoming increasingly popular compared to conventional open surgical tracheostomy in ICU. Methods: A prospective randomized trial with twenty patients in each group was conducted to compare the outcomes of percutaneous and surgical tracheostomy. Percutaneous tracheostomy was performed using Ciaglia Blue Rhino technique and surgical tracheostomy was performed using established technique. The outcomes were compared in relation to randomization to tracheostomy, completion of procedure, intra operative and post-operative complications, hospital length of stay and cost. Results: There were no major complications in either group. Most variables studied were not statistically significant. The two groups did not differ in terms of basic demographics or APACHE II score. The only variables to reach statistical significance were time duration from tracheostomy randomization to start of procedure and time taken for completion of procedure. It was mean 31.85±15.35 hours in Percutaneous Tracheostomy group and in Surgical Tracheostomy group it was mean 49.10±23.61 hours respectively (p<0.009). Time taken to perform percutaneous tracheostomy was mean 15.50±3.22 minutes and for surgical tracheostomy it was mean 20.30±3.38 minutes. (p<0.001). Conclusion: Percutaneous dilatational tracheostomy is simple, faster to perform and can be done at bedside to avoid considerable delay in the performance of open tracheostomy where there is high demand for elective and emergency procedures in operating room.  

scholarly journals Percutaneous Dilatational Tracheostomy and Modifications in Intensive Care Unit Patients

2019 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill Patients ◽  
Safety Profile ◽  
Percutaneous Dilatational Tracheostomy ◽  
Complication Rates ◽  
Surgical Tracheostomy ◽  
Common Indication ◽  
Dilatational Tracheostomy ◽  
Prolonged Ventilation

Percutaneous dilatational tracheostomy (PDT) is a commonly performed procedure in critically ill patients [1]. It can be safely performed bedside. This has resulted in decline in the use of surgical tracheostomy except in few selected cases. Over the last 10 years data on newer methods of insertion, timing, safety profile and complication rates has been published, which has greatly improved our understanding of this procedure [2]. The most common indication of tracheostomy in the ICU is the need for prolonged ventilation. Less complication occur with an increase in skills. Many methods of performing PDT have been discovered recently [3]. Bronchoscopy has been found to be beneficial procedural aides the PDT [4]. In our study, a brief overview about the use of PDT in ICU and, different percutaneous techniques will be discussed. The conclusion is that percutaneous tracheostomies offer benefits for some of the outcomes when compared with surgical tracheostomies.

scholarly journals The provision of surgical tracheostomies by maxillofacial surgeons in the UK: time for a dedicated tracheostomy team?

2018 ◽  
Vol 100 (2) ◽  
pp. 116-119
Author(s):  
P Chohan ◽  
R Elledge ◽  
MK Virdi ◽  
GM Walton
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Telephone Survey ◽  
Percutaneous Dilatational Tracheostomy ◽  
Maxillofacial Surgery ◽  
University Hospital ◽  
Oral And Maxillofacial Surgery ◽  
Surgical Tracheostomy ◽  
Surgical Teams ◽  
The Uk

Surgical tracheostomy is a commonly provided service by surgical teams for patients in intensive care where percutaneous dilatational tracheostomy is contraindicated. A number of factors may interfere with its provision on shared emergency operating lists, potentially prolonging the stay in intensive care. We undertook a two-part project to examine the factors that might delay provision of surgical tracheostomy in the intensive care unit. The first part was a prospective audit of practice within the University Hospital Coventry. This was followed by a telephone survey of oral and maxillofacial surgery units throughout the UK. In the intensive care unit at University Hospital Coventry, of 39 referrals, 21 (53.8%) were delayed beyond 24 hours. There was a mean (standard deviation) time to delay of 2.2 days (0.9 days) and the most common cause of delay was surgeon decision, accounting for 13 (61.9%) delays. From a telephone survey of 140 units nationwide, 40 (28.4%) were regularly involved in the provision of surgical tracheostomies for intensive care and 17 (42.5%) experienced delays beyond 24 hours, owing to a combination of theatre availability (76.5%) and surgeon availability (47.1%). There is case for having a dedicated tracheostomy team and provisional theatre slot to optimise patient outcomes and reduce delays. We aim to implement such a move within our unit and audit the outcomes prospectively following this change.

scholarly journals The Use of Fiberoptic Bronchoscopy During Percutaneous Dilatational Tracheostomy With Laryngeal Mask

1997 ◽  
Vol 4 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Maurizio Rossi ◽  
Marco De Monti ◽  
Davide Sonnino ◽  
Bruno Giacometti
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Percutaneous Dilatational Tracheostomy ◽  
Fiberoptic Bronchoscopy ◽  
Laryngeal Mask ◽  
Obese Patients ◽  
Limited Mobility ◽  
Dilatational Tracheostomy ◽  
Combined Use

The aim of our research is to evaluate the advantage by the combined use of fiberoptic bronchoscopy and laryngeal mask during the performance of percutaneous dilatational tracheostomy in an intensive care unit.Patients: 16 adult patients who were candidates to middle-long term mechanical ventilation.Environment: Intensive Care Unit of a Community General Hospital.Results: We experienced 3 minor complications (2 minor bleedings and 1 neck emphysema). Difficulties were found in 3 patients with particular anatomical conformation (obese patients with short neck and limited mobility of the cervical spine).Conclusion: The combined use of fiberoptic tracheo-bronchoscopy with the laryngeal mask permits a better endoscopic visualisation of the operatory field, providing a more secure and precise procedure.

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