ANIŞ ANBOĞAN, UĞUR ORAL, HASAN AKMAN, MURAT GÜNDÜZ, HANDAN BİRBİÇER, EGEMEN BİLGİN, ELİF REYHAN, NURCAN DORUK
Annals of Medical Sciences - 2000;9(2):70-74
Purpose: The purpose of this study was to evaluate the safety and utility of a percutaneous dilatational tracheostomy procedure in intensive care unit patients. Methods: During a 18 month period (1996-1998) elective percutaneous dilatational tracheostomy was performed in 157 critically ill patients in the reanimation unit using one-step dilatation technique with a set of special forceps. In all patients, procedure time, acute and late percutaneous dilatational tracheostomy complications were assessed and the results of each six-month periods were compared. Student's-t and chi-square tests were used for statistical analysis. p<0.05 was considered statistically significant Results: The indications for tracheostomy were prolonged mechanical ventilation in 124 patients (78.98%) and a safe airway requirement in 33 spontaneous breathing patients (21.02%). In the three six-month period, procedure times were12.1±1.3, 11.3±1.2, 13.03±0.9 minutes and the complication rates were 23%, 12.7% and 5.1%, respectively (p>0.05 and p<0.05). The loss of airway with subcutaneous emphysema was seen in 3 patients and pneumothorax occurred in 2 of these patients in the first period (p<0.05). Pneumothorax was not seen in the other two periods and subcutaneous emphysema occurred only in 1 patient in the third period (p>0.05). The bleeding was assessed in 5 patients and minimal stomal infection in 4 patients. There were no significantly difference between the periods (p>0.05). All patients were decannulated successfully with aesthetic skin scar and only in 1 patients severe tracheal stenosis was occurred. Conclusion: In conclusion we decided that percutaneous dilatational tracheostomy was a simple, fast and safe procedure to maintain an artificial airway in critically ill patients. We also suggested that the proper patient selection with the gaining PDT experience should decrease the rate of possible PDT complications.
