Comparison of the effects of different percutaneous tracheotomy techniques on acute tracheal trauma

As it can easily be performed at the bedside with minimal morbidity, percutaneous dilatational tracheotomy (PDT) is preferred over surgical tracheotomy. The aim of this study is to compare the effects of different PDT techniques on posterior tracheal wall injury. Materials and methods: The study was conducted at the Gazi University Laparoscopy Training Center after approval was granted by the ethics committee. After sedation with xylazine/ketamine, electrocardiography, peripheral oxygen saturation, and blood pressure were monitored. Propofol was used to achieve the desired level of sedation during the procedure. There were 16 pigs, randomly allocated into 4 groups. Multiple, single, forceps, and twist dilator techniques were performed in groups I, II, III, and IV, respectively. At the end of the course all pigs were sacrificed and tracheas were harvested for macroscopic and histopathological evaluation. Results: Macroscopic evaluation revealed erythematous/hemorrhagic and ulcerative lesions on the posterior wall of all samples. Histopathological injury was observed in all samples and was similar in all groups. Procedural time was significantly longer in group I than in all other groups (P < 0.05). Conclusion: Although the results are conflicting, bronchoscopy-aided PDT is believed to reduce complications. In our study, PDTs were performed without bronchoscopy, and posterior wall injury was observed in all samples. Therefore, we suggest using bronchoscopy to reduce procedure-related complications and improve patient safety during PDT.

Comparison of the effects of different percutaneous tracheotomy techniques on acute tracheal trauma

As it can easily be performed at the bedside with minimal morbidity, percutaneous dilatational tracheotomy (PDT) is preferred over surgical tracheotomy. The aim of this study is to compare the effects of different PDT techniques on posterior tracheal wall injury. Materials and methods: The study was conducted at the Gazi University Laparoscopy Training Center after approval was granted by the ethics committee. After sedation with xylazine/ketamine, electrocardiography, peripheral oxygen saturation, and blood pressure were monitored. Propofol was used to achieve the desired level of sedation during the procedure. There were 16 pigs, randomly allocated into 4 groups. Multiple, single, forceps, and twist dilator techniques were performed in groups I, II, III, and IV, respectively. At the end of the course all pigs were sacrificed and tracheas were harvested for macroscopic and histopathological evaluation. Results: Macroscopic evaluation revealed erythematous/hemorrhagic and ulcerative lesions on the posterior wall of all samples. Histopathological injury was observed in all samples and was similar in all groups. Procedural time was significantly longer in group I than in all other groups (P < 0.05). Conclusion: Although the results are conflicting, bronchoscopy-aided PDT is believed to reduce complications. In our study, PDTs were performed without bronchoscopy, and posterior wall injury was observed in all samples. Therefore, we suggest using bronchoscopy to reduce procedure-related complications and improve patient safety during PDT.

___

  • Petros S, Engelmann L. Percutaneous dilatational tracheos- tomy in a medical ICU. Intensive Care Med 1997; 23: 630–4. 5. Gardiner Q, White PS, Carson D, Shearer A, Frizelle F, Dunk- ley P. Technique training: endoscopic percutaneous tracheos- tomy. Br J Anaesth 1998; 81: 401–3.
  • Frova G, Quintel M. A new simple method for percutaneous tracheostomy: controlled rotating dilation. Intensive Care Med 2002; 28: 299–303.
  • Nickells JS, Dahlstrom JE, Bidstrup H, Dobbinson TL. Acute tracheal trauma in sheep caused by percutaneous tracheosto- my. Anaesth Intensive Care 2002; 30: 619–23. 8. Sengupta N, Ang KL, Prakash D, Ng V, George SJ. Twenty months’ routine use of a new percutaneous tracheostomy set us- ing controlled rotating dilation. Anesth Analg 2004; 99: 188–92.
  • Youssef TF, Ahmed MR, Saber A. Percutaneous dilatational versus conventional surgical tracheostomy in intensive care patients. N Am J Med Sci 2011; 3: 508–12.
  • Delaney A, Bagshaw SM, Nalos M. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill pa- tients: a systematic review and meta-analysis. Crit Care 2006; 10: R55.
  • Bacchetta MD, Girardi LN, Southard EJ, Mack CA, Ko W, Tor- tolani AJ, Krieger KH, Isom OW, Lee LY. Comparison of open versus bedside percutaneous dilatational tracheostomy in the cardiothoracic surgical patients: outcomes and financial analy- sis. Ann Thorac Surg 2005; 79: 1879–85.
  • Lin JC, Maley RH Jr, Landreneau RJ. Extensive posterior-lat- eral tracheal laceration complicating percutaneous dilational tracheostomy. Ann Thorac Surg 2000; 70: 1194–6.
  • Gilbey P. Fatal complications of percutaneous dilatational tra- cheostomy. Am J Otolaryngol 2012; 33: 770–3.
  • Fernandez L, Norwood S, Roettger R, Gass D, Wilkins H III. Bedside percutaneous tracheostomy with bronchoscopic guid- ance in critically ill patients. Arch Surg 1996; 131: 129–32.
  • Trottier SJ, Hazard PB, Sakabu SA, Levine JH, Troop BR, Thompson JA, McNary R. Posterior tracheal wall perforation during percutaneous dilational tracheostomy: an investigation into its mechanism and prevention. Chest 1999; 115: 1383–9.
  • Fikkers BG, van Veen JA, Kooloos JG, Pickkers P, van den Hoogen FJ, Hillen B, van der Hoeven JG. Emphysema and pneumothorax after percutaneous tracheostomy: case reports and an anatomic study. Chest 2004; 125: 1805 –14.
  • Johnson JL, Cheatham ML, Sagraves SG, Block EF, Nelson LD. Percutaneous dilational tracheostomy: a comparison of single- versus multiple-dilator techniques. Crit Care Med 2001; 29: 1251–4.
  • Cantais E, Kaiser E, Le-Goff Y, Palmier B. Percutaneous tra- cheostomy: prospective comparison of translaryngeal tech- nique versus the forceps-dilational technique in 100 critically ill adults. Crit Care Med 2002; 30: 815–9.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK
Sayıdaki Diğer Makaleler

Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism

Umut Yücel ÇAVUŞ, Sinan YILDIRIM, Ertan SÖNMEZ, Çağatay ERTAN, Özcan ÖZEKE

Attachment style and perceived social support as predictors of biopsychosocial adjustment to cancer

Ayşe Gül YILMAZ ÖZPOLAT, Tuğba AYAZ, Özlem KONAĞ, Asiye ÖZKAN

Increasing resistance of nosocomial Acinetobacter baumannii: are we going to be defeated?

Tümer GÜVEN, Gülruhsar YILMAZ, Hatice Rahmet GÜNER, Ayşe Kaya KALEM, Fatma ESER, Mehmet Akın TAŞYARAN

An investigation of pulmonary findings of Crimean Congo haemorrhagic fever patients

Sami KINIKLI, Ali Pekcan DEMİRÖZ, Gülden BİLGİN, Şerife ALTUN, Çiğdem HATİPOGLU ATAMAN, Cemal BULUT

PUVA phototherapy-induced secondary amyloidosis in patients with mycosis fungoides: a rare adverse effect of phototherapy

İtır Ebru ZEMHERİ, Sıdıka Şeyma ÖZKANLI, İlkin ZİNDANCI, Serkan ŞENOL, Özge AKBULAK, Filiz Topaloğlu DEMİR

Choroidal thickness in healthy Turkish subjects

Erol COŞKUN, Seydi OKUMUŞ, Bülent GÜRLER, Ramazan YAYUSPAYI, Burak ÖREN, Erdal KAYDU, Ayşegül ÇÖMEZ, İbrahim ERBAĞCI

Distal radius measurements and efficacy of fixed-angle locking volar plates

İsmail AĞIR, Mahmut Nedim AYTEKİN, Fatih KÜÇÜKDURMAZ, Onur BAŞCI, Cihangir TETİK

Ocular surface culture changes in patients after septoplasty

Mahmut ÖZKIRIŞ, Zeliha KAPUSUZ GENCER, Çiğdem KADER, Levent SAYDAM

Bone mineral density and vitamin D status in children and adolescents with congenital adrenal hyperplasia

Fatma DEMİREL, Özlem KARA, Derya TEPE, İhsan ESEN

Is perioperative examination of frozen sections necessary in nephron-sparing surgery?

Mehmet KALKAN, Soner YALÇINKAYA, Coşkun ŞAHİN, Yeşim ÜÇKURT, Ömer ETLİK