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 The percutaneous dilatational tracheostomy in the intensive care unit - our experience

2018 ◽  
Vol 71 (suppl. 1) ◽  
pp. 77-82
Author(s):  
Vladimir Dolinaj ◽  
Sanja Milosev ◽  
Gordana Jovanovic ◽  
Ana Andrijevic ◽  
Nensi Lalic ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Prothrombin Time ◽  
Prolonged Mechanical Ventilation ◽  
Percutaneous Tracheostomy ◽  
Percutaneous Dilatational Tracheostomy ◽  
Seldinger Technique ◽  
Dilatational Tracheostomy ◽  
Tracheal Cannula

Percutaneous tracheostomy is a commonly carried out procedure in patients in the Intensive Care Unit. Percutaneous dilatational tracheostomy consists of the introduction of a tracheal cannula from the front of the neck, through blunt dissection of the pretracheal tissues, using a guide by Seldinger technique. When percutaneous dilatational tracheostomy procedure was introduced in routine clinical practice in the Clinical Center of Vojvodina, procedural protocol was established. This Protocol includes: 1. indications, contraindications and timing for percutaneous dilatational tracheostomy, 2. assessment of the patient, 3. preparation of the patient and equipment, 4. procedure description, 5. potential complications and complication management. At our institution percutaneous dilatational tracheostomy is performed on an individual patient basis assessment within 5-7 days following translaryngeal intubation. Routinely the platelet count, activated prothrombin time and prothrombin time are checked. The patient?s neck is assessed clinicaly and by the use of fiberoptic bronchoscope and ultrasound. At our institution we use the modified Ciaglia technique of the percutaneous dilatational tracheostomy-Ciaglia Single Dilatator method with the TRACOE? experc Set vario which includes spiral rein?forced tracheal cannula. At the end of procedure fiberoptic evaluation of the tracheobroinchial tree is made and chest X-ray is done. Percutaneous dilatational tracheostomy is a simple, safe, and effective procedure performed in the Intensive Care Unit. It is the preferred technique of airway management in the Intensive Care Units in the patients requiring prolonged mechanical ventilation, tracheobronchial hygiene and weaning from mechanical ventilation.

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 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 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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