Erdinc KOCA, Cigdem Firat KOCA, Ahmet KİZİLAY, Tuba BAYİNDİR

Percutaneous or surgical tracheotomy when, why, and selection criteria

Amaç: Trakeotomi; özellikle yoğun bakımlarda en sık uygulanan prosedürlerden biridir. Ve en temel endikasyonu uzamış entübasyondur. Trakeotomi uzamış mekanik ventilasyon desteği veya hava yolunu korumak için uygulanan bir prosedürdür. Bu yolla akciğerleri koruma ve mekanik ventilasyondan uyanma daha kolay ve konforlu olacaktır. Trakeotomi hasta toleransını arttırır, sedasyon ihtiyacını azaltır, laringeal irritasyonu engeller, hemşirelik bakımını kolaylaştırır ve ölü boşluğu azaltır. Yoğun bakım hastalarının yaklaşık %8-24 üne trakeotomi prosedürü uygulanmaktadır. Bu karar, uzamış entübasyona karşı trakeotominin yararına, hastadan beklenen klinik sonuçlara ve riske göre bireyseldir. Ancak prosedürün zamanlaması hakkında hala tam bir konsensus bulunmamaktadır. Klasik olarak trakeotomi prosedürü ventilasyondan 10-14 günde uyanamayacak hastalarda ve optimal koşullarda planlanmalıdır. Trakeotomi oranı son dekadda artış göstermiştir. Ama prosedür için optimal zaman, hasta seçim kriterleri, teknik tipi ve dekanülasyon zamanı hakkında hala bir konsensus bulunmamaktadır. En yaygın, geleneksel trakeotomi yöntemi, operasyon odasında gerçekleştirilen açık cerrahi trakeotomi yaklaşımıdır. Perkütan teknik ise nisbeten daha kolay bir tekniktir. Ve daha kısa süreye sahip bir prosedürdür. Perkütan trakeotomi cerrahi trakeotomiye alternatif, maliyet etkinliği olan, hızlı, kolay, güvenli ve popüler bir yöntem haline gelmiştir. Optimal bir trakeotomi yöntemi yoktur, klinisyen en iyi tekniği hastaya ve uygun zamana göre seçmelidir. Ama; optimal prosedür zamanı, hasta seçim kriterleri, teknik tipi ve dekanülasyon zamanı hakkında hala tam bir konsensus bulunmamaktadır

Perkütan veya cerrahi trakeotomi, ne zaman? neden? ve seçim kriterleri

Aim: Tracheotomy is one of the most frequent procedure especially in the intensive care units (ICU). And the major indication is prolonged respiratory support. Tracheotomy is a procedure for patients who need prolonged mechanical ventilation support or airway protection. By this way, the respiratory care and weaning from mechanical ventilatory support become easier and comfortable. Tracheotomy improves patient tolerance, reduces the need for sedation, avoids laryngeal irritation, enhances nursing care, reduces dead space. Among the ICU patients, 824% of all, undergo tracheotomy procedure. This decision is individually based on the risk and benefits of tracheotomy versus prolonged intubation and also the consent of the patient's relations and expected clinical outcomes. But there is stil no consensus about the timing of the procedure. Clasically, the most considered opinion for tracheotomy in patients that are unable to wean from invasive ventilation within 10-14 days of intubation and should be planned under optimal conditions. The tracheotomy range increased over the last decade. But there is stil no consensus about the optimal timing for procedure, criterias for selection of patients, type of technique and timing of decannulation. The most common, traditional method is open surgical approach; performed in the operating room. Percutaneous technique is relatively simple to perform. And has a shorter procedure time. Percutaneous tracheotomy has become a popular, cost-effective, quick, simple and safe alternative to surgical tracheostomy. There is not an optimal tracheostomy, the physician should choose the best technique according to the patient and at the right time

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