중환자실 환자에서 관혈적 기관 절개술과 경피적 확장 기관 절개술의 비교
Comparison of Surgical Tracheostomy and Percutaneous Dilatational Tracheostomy in Intensive Care Unit Patients
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Background and Objectives Percutaneous dilatational tracheostomy (PDT) has becomean increasingly popular method of establishing an airway for patients in need of chronic ventilatorassistance. The aim of this study is to assess and compare two main strategies for doingtracheostomy: traditional open surgical tracheostomy (ST) and PDT. Materials and Method We retrospectively reviewed medical records of 43 patients who underwenttracheostomy between the years 2016 and 2017. All patients were under intensive careunit (ICU) care and referred to the department of otolaryngology for tracheostomy. All tracheostomieswere performed at the bedside using either percutaneous dilatational technique oropen surgical technique by a single surgeon. In cases of PDT, either blind puncture techniquewithout any guidance or laryngoscopy-guided puncture technique was used. Demographic andprocedural variables and complications were compared between the two groups. Results PDT was performed in 29 patients and ST in 14 patients. Of those who underwentPDT, 15 patients received the blind puncture technique and 14 patients laryngoscopy-guidedpuncture technique. The cricosternal distance was longer and the amount of blood loss and durationof the procedure was lesser in the PDT group. In the PDT group, there was no differencein blood loss nor in the duration of the procedure according to the puncture technique, whereascritical complications occurred more frequently when the blind technique was used. Subjectivedifficulty of the procedure is predictive of complications. Conclusion The study show that PDT is a useful and safe procedure for ICU patients. Also,guidance on using the flexible laryngoscopy during PDT can prevent severe complications.
Abstract
Background and Objectives Percutaneous dilatational tracheostomy (PDT) has becomean increasingly popular method of establishing an airway for patients in need of chronic ventilatorassistance. The aim of this study is to assess and compare two main strategies for doingtracheostomy: traditional open surgical tracheostomy (ST) and PDT. Materials and Method We retrospectively reviewed medical records of 43 patients who underwenttracheostomy between the years 2016 and 2017. All patients were under intensive careunit (ICU) care and referred to the department of otolaryngology for tracheostomy. All tracheostomieswere performed at the bedside using either percutaneous dilatational technique oropen surgical technique by a single surgeon. In cases of PDT, either blind puncture techniquewithout any guidance or laryngoscopy-guided puncture technique was used. Demographic andprocedural variables and complications were compared between the two groups. Results PDT was performed in 29 patients and ST in 14 patients. Of those who underwentPDT, 15 patients received the blind puncture technique and 14 patients laryngoscopy-guidedpuncture technique. The cricosternal distance was longer and the amount of blood loss and durationof the procedure was lesser in the PDT group. In the PDT group, there was no differencein blood loss nor in the duration of the procedure according to the puncture technique, whereascritical complications occurred more frequently when the blind technique was used. Subjectivedifficulty of the procedure is predictive of complications. Conclusion The study show that PDT is a useful and safe procedure for ICU patients. Also,guidance on using the flexible laryngoscopy during PDT can prevent severe complications.
참고문헌 (17)
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