Mekanik dolaşım destek cihazı olan hastalarda perkütan dilatasyonel trakeostomi: İşlem güvenli midir?

Amaç: Bu çalışmada kalp cerrahisi sonrasında ekstrakorporeal membran oksijenizasyonu veya sol ventrikül destek cihazı uygulanan hastalarda perkütan dilatasyonel trakeostomi işleminin etkinliği ve güvenliliği araştırıldı. Çalışma planı: Ocak 2017 - Ocak 2019 tarihleri arasında ekstrakorporeal membran oksijenizasyonu veya sol ventrikül destek cihazı desteği ile perkütan dilatasyonel trakeostomi uygulanan toplam 42 hasta (10 erkek, 32 kadın; ort. yaş 51±14.6 yıl; dağılım 18-77 yıl) retrospektif olarak incelendi. Laboratuvar verileri, Basitleştirilmiş Akut Fizyoloji Skoru-II ve Ardışık Organ Yetmezliği Değerlendirme skorları ve majör ve minör komplikasyonlar kaydedildi. Hastaların 30 günlük ve bir yıllık takip sonuçları gözden geçirildi. Bulgular: Kırk iki hastanın 17ʼsine (%42.5) sol ventrikül destek cihazı, 14'üne (%33.3) ekstrakorporeal membran oksijenizasyonu ve 11'ine (%26.2) ekstrakorporeal membran oksijenizasyonu + sol ventrikül destek cihazı uygulandı. Perkütan dilatasyonel trakeostomi sırasında, hastaların laboratuvar değerleri şu şekildeydi: uluslararası normalleştirilmiş oran 2.3±0.9, parsiyel tromboplastin zamanı 59.4±19.5 sn., trombosit sayısı 139.2±65.8×109 /L, hemoglobin 8.8±1.0 g/dL ve kreatinin 1.6±1.0 mg/dL olarak saptandı. İşlem sırası ölüm, majör komplikasyon veya kanama gözlenmedi. Dört hastada (%8.3) lokal stomada sızıntı ve üç hastada (%6.2) lokal stoma enfeksiyonu şeklinde minör komplikasyonlar gözlendi. Sonuç: Çalışma sonuçlarımız, perkütan dilatasyonel trakeostominin bu hasta grubunda etkili ve güvenli bir teknik olduğunu göstermektedir.

Percutaneous dilatational tracheostomy in patients with mechanical circulatory support: Is the procedure safe?

Background: We aimed to investigate the efficacy and safety ofpercutaneous dilatational tracheostomy procedure following cardiacsurgery in patients receiving extracorporeal membrane oxygenationand/or left ventricular assist device.Methods: A total of 42 patients (10 males, 32 females; mean age51±14.6 years; range, 18 to 77 years) who underwent percutaneousdilatational tracheostomy procedure under extracorporeal membraneoxygenation and/or left ventricular assist device support betweenJanuary 2017 and January 2019 were retrospectively analyzed.Laboratory data, Simplified Acute Physiology Score-II andSequential Organ Failure Assessment scores, and major and minorcomplications were recorded. The 30-day and one-year follow-upoutcomes of the patients were reviewed.Results: Of 42 patients, 17 (42.5%), 14 (33.3%), and 11 (26.2%) receivedleft ventricular assist device, extracorporeal membrane oxygenation,and extracorporeal membrane oxygenation + left ventricular assistdevice, respectively. During percutaneous dilatational tracheostomy,the laboratory values of the patients were as follows: internationalnormalized ratio, 2.3±0.9; partial thromboplastin time, 59.4±19.5 sec;platelet count, 139.2±65.8×109/L, hemoglobin, 8.8±1.0 g/dL, andcreatinine, 1.6±1.0 mg/dL. No peri-procedural mortality, majorcomplication, or bleeding was observed. We observed minorcomplications including localized stomal ooze in four patients (8.3%)and local stomal infection in three patients (6.2%).Conclusion: Our study results suggest that percutaneous dilatationaltracheostomy is an effective and safe technique in this patientpopulation.

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