Mustafa Özgür CIRIK, Güler ERASLAN DOĞANAY

Yoğun Bakım Ünitesinde Fiberoptik Bronkoskopi Eşliğinde Uygulanan Perkütan Trakeostomilerin Retrospektif Değerlendirilmesi

ÖZET(TR) Amaç Perkütan Dilatasyonel Trakeostomi (PDT) yoğun bakım ünitelerinde uzun süreli mekanik ventilatör ihtiyacı bulunan ve çeşitli sebeplerle hava yolu gerektiren hastalarda yatak başı uygulanabilen bir işlemdir.İşlemin fiber optik bronkoskopi (FOB) ile yapılması kolaylık sağlar ve komplikasyonları azaltır. Bu çalışmada yoğun bakımda FOB eşliğinde açılan PDT’lerin etkinliğini ve komplikasyonları değerlendirmeyi amaçladık. Gereç ve Yöntem 05.03.2020/665 sayılı onay alınarak hastanemiz Anestezi Yoğun Bakım Ünitesi’nde 01 Ocak 2018-07 Temmuz 2020 tarihleri arasında FOB eşliğinde Griggs yöntemi ile PDT açılan 110 hasta retrospektif olarak değerlendirildi.Hastaların demografik verileri, tanıları, comorbiditeleri, mekanik ventilasyon süreleri, gelişen komplikasyonlar, prognozları, 28 ve 90 günlük mortaliteleri retrospektif olarak kaydedildi. Bulgular Çalışmaya 96 hasta dahil edildi. Yaş ortalaması 70,54 idi. Hastaların 58’i kronik obstrüktif akciğer hastalığı (KOAH) ,16 tanesi akciğer malignitesi, 22’si nörolojik hastalıklar nedeniyle PDT açılan hastalardı.Hastalardan 43 tanesi ev tipi mekanik ventilatöre geçilip palyatif servise nakledilmiş, 13 tanesi ev tipine geçilmeden dış palyatif merkeze sevk edilmiştir. Ortalama işlem süreleri nörolojik grupta 12dk, KOAH grubunda 13dk, malign grupta 14dk idi. Komplikasyon oranımız %17.7 idi.28 günlük mortalite nörolojik hasta grubunda malign hasta grubuna göre; malign hasta grubunda KOAH hasta grubuna göre daha düşüktü. Sonuç FOB eşliğinde açılan PDT’lerde işlem daha kısa süreli ve komplikasyonlar daha az olduğundan FOB kullanımının yaygınlaşması gerektiğini düşünmekteyiz.

Anahtar Kelimeler:

yoğun bakım, trakeostomi, fiber optik bronkoskopi, perkütan dilatasyonal trakeostomi, Griggs, mortalite

ABSTRACT Aim Percutaneous Dilatational Tracheostomy (PDT) is a bedside procedure that can be performed in intensive care units in patients who need a long-term mechanical ventilator and require airway for various reasons. Performing the procedure with fiber optic bronchoscopy (FOB) provides convenience and reduces complications. In this study, we aimed to evaluate the effectiveness and complications of PDTs opened with FOB in intensive care. Material and Metod With the approval numbered 05.03.2020 / 665, 110 patients who underwent PDT with FOB and Griggs method in Intensive Care Unit between the date 1st January 2018 and 7 th July 2020 were retrospectively evaluated. The demographic data, diagnoses, comorbidities, duration of mechanical ventilation, complications, prognosis, 28 and 90-day mortality were recorded retrospectively. Results 96 patients were included in the study. Average age was 70.54. 58 of the patients were underwent PDT due to chronic obstructive pulmonary disease (COPD), 16 due to lung malignancy, 22 due to neurological diseases. 43 of the patients were transferred to the palliative service with home mechanical ventilation, 13 of them were referred to an external palliative center.Average procedure times were 12 min. in the neurological group, 13 min. in the COPD group, 14 min. in the malignant group.Our complication rate was 17.7%. 28-day mortality was lower in the neurological group to the malignant group; and was lower in the malignant group to the COPD group. Conclusion We think that the use of FOB should become widespread since the procedure is shorter and the complications are less in PDTs opened with FOB.

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