Research Article
BibTex RIS Cite

YOĞUN BAKIMDA PERKÜTAN VE CERRAHİ TRAKEOSTOMİ DENEYİMLERİMİZ

Year 2020, Volume: 22 Issue: 2, 192 - 198, 31.08.2020

Dilek Destegül Fazilet Kocaöz Özlem Özkan Kuşcu

Abstract

Amaç: Bu çalışmada perkütan ve cerrahi yöntemlerle trakeostomi açılan 168 hastanın retrospektif sunulması amaçlandı.
Gereç ve Yöntemler: Çalışmada Ocak 2015-Aralık 2017 tarihleri arasında Niğde Ömer Halisdemir Üniversitesi Eğitim ve Araştırma Hastanesi 3. Basamak Yoğun Bakım Ünitesinde trakeostomi açılan hastaların demografik verileri, yatış tanısı, yatış süresi, entübasyon süresi, entübasyondan trakeostomi açılana kadar geçen süre, işlem süresi, trakeostominin erken ve geç komplikasyonları, Acute Physiology and Chronic Health Evaluation II Score (APACHE II skoru) ile prognoz korelasyonu retrospektif olarak incelendi. Veriler, hastane veri sisteminden ve hasta dosyalarından elde edildi.
Bulgular: Çalışmaya 168 hasta dahil edildi. Yüz altmış sekiz hastanın %45.8 (n=76)’i kadın; yaş ortalaması 65.61±18.42 yıl, APACHE II skoru median 29.83±6.92 bulundu. Kronik obstrüktif akciğer hastalığı alevlenmesi, en sık yoğun bakım yatış nedeniydi (n=44, %26.2). Hastaların 126 (%75)’sına perkütan teknikle trakeostomi açılmıştı. Cerrahi teknikte majör perioperatif kanama (n=2), perkütan teknikte desatürasyon (n=4) ve trakeoözefageal fistül (n=1) görülen komplikasyonlardı. Yirmi yedi hastaya 10 günden daha kısa sürede trakeostomi açılmıştı. Trakeostomi işlemine kadar geçen süre ile yoğun bakımda ve hastanede yatış süreleri arasında korelasyon bulunmaktaydı (p<0.0001). İki grup arasında mortalite oranı açısından istatistiksel anlamlı fark bulunmamaktaydı (p=0.212).
Sonuç: Erken trakeostomi açılması, hastaların yoğun bakımda ve hastanede kalış süresini anlamlı kısaltmaktadır. Perkütan dilatasyonel trakeostomi tekniği ise yoğun bakım hastalarında elektif trakeostomi işleminde cerrahi trakeostomiye alternatif olarak tercih edilebilir.

Keywords

Trakeostomi yoğun bakım mortalite

References

  • 1. Priest RE. LXXXI History of tracheotomy. Ann Otol, Rhinol & Laryngology. 1952;61(4):1039-45.
  • 2. Jackson C. Tracheotomy. The Laryngoscope. 1909;19(4):285-90.
  • 3. Galloway TC. Tracheotomy in bulbar poliomyelitis. JAMA. 1943;123(17):1096-97.
  • 4. Nelson-Jones A, Williams RH Hunt. Tracheotomy in bulbar poliomyelitis. The Lancet. 1945;245(6349):561-3.
  • 5. Ciaglia P, Firsching, R, Syniec C. Elective percutaneous dilatational tracheostomy: a new simple bedside procedure; preliminary report. Chest. 1985;87(6):715-19.
  • 6. Griggs WM, Myburgh JA, Worthley LIG. A prospective comparison of a percutaneous tracheostomy technique with standard surgical tracheostomy. Intens Care Med. 1991;17(5):261-63.
  • 7. Esteller-Moré E, Ibañez J, Matino E, Ademà JM, Nolla M & Quer IM. Prognostic factors in laryngotracheal injury following intubation and/or tracheotomy in ICU patients. Eur Arch Oto-Rhino-Laryngol Head & Neck. 2005;262(11):880-3.
  • 8. Friedman Y. Indications, timing, techniques, and complications of tracheostomy in the critically ill patient. Curr Opin Crit Care. 1996;2(1):47-53.
  • 9. Esteban A, Anzueto A, Alia I, Gordo F, Apezteguia C, Palizas F et al. How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Resp Crit Care Med. 2000;161(5):1450-58.
  • 10. Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB, Vivaldi, N. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. Jama. 2010;303(15):1483-89.
  • 11. Diehl JL, Atrous SE, Touchard D, Lemaire F, Brochard L. Changes in the work of breathing induced by tracheotomy in ventilator-dependent patients. Am J Resp Crit Care Med. 1999;159(2):383-8.
  • 12. Jaeger JM, Littlewood Keith A, Durbin Jr CG. The role of tracheostomy in weaning from mechanical ventilation. Resp Care. 2002;47(4):469-80.
  • 13. Nieszkowska A, Combes A, Luyt CE, Ksibi H, Trouillet JL, Gibert C et al. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med. 2005;33(11):2527-33.
  • 14. Freeman BD, Isabella KL, Buchman TG. A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest. 2000;118(5):1412-18.
  • 15. Antonelli M, Michetti V, Di Palma A, Conti G, Pennisi MA, Arcangeli A et al Percutaneous translaryngeal versus surgical tracheostomy: a randomized trial with 1-yr double-blind follow-up. Crit Care Med. 2005;33(5):1015-20.
  • 16. Friedman Y, Mizock BA. Percutaneous versus surgical tracheostomy: procedure of choice or choice of procedure. Crit Care Med. 1999;27(8):1684-85.
  • 17. Mirski MA, Pandian V, Bhatti N, Haut E, Feller-Kopman D, Morad A et al. Safety, efficiency, and cost-effectiveness of a multidisciplinary percutaneous tracheostomy program. Crit Care Med. 2012;40(6):1827-34.
  • 18. Vargas M, Sutherasan Y, Antonelli M, Brunetti I, Corcione A, Laffey JG et al. Tracheostomy procedures in the intensive care unit: an international survey. Crit Care. 2015;19:291.
  • 19. Hacı C, Açıkalın RM, Akkoç İ, Toptaş M. Perkütan ve cerrahi trakeostomilerin avantaj ve dezavantajlarının araştırılması. Mel Bul Haseki. 2018;56(1). Doi:10.4274/haseki.66375.
  • 20. Heikkinen M, Aarnio P, Hannukainen J. Percutaneous dilational tracheostomy or conventional surgical tracheostomy? Crit Care Med. 2000;28(5):1399-1402.
  • 21. Sağıroğlu AE, Ağkoç E, Doğan Y, Gömeçlioğlu V, Orhon Z, Yavaş C Yoğun bakım ünitesinde perkütan ve cerrahi trakeostominin karşılaştırılması. Göztepe Tıp Dergisi. 2010;25:67-70.
  • 22. Higgins KM, Punthakee X. Meta‐analysis comparison of open versus percutaneous tracheostomy. Laryngoscope. 2007;117(3):447-54.
  • 23. Putensen C, Theuerkauf N, Guenther U, Vargas M, Pelosi P. Percutaneous and surgical tracheostomy in critically ill adult patients: a meta-analysis. Crit Care Med. 2014;18(6):544.
  • 24. Silvester W, Goldsmith D, Uchino S, Bellomo R, Knight S, Seevanayagam S et al. Percutaneous versus surgical tracheostomy: a randomized controlled study with long-term follow-up. Crit Care Med. 2006;34(8):2145-52.
  • 25. Reed MF, Mathısen DJ. Tracheoesophageal fistula. Chest Surg Clin N Am. 2003;13(2):271-89.
  • 26. Düger C, İsbir AC, Uysal İÖ, Kol İÖ, Kaygusuz K, Gürsoy S et al. Yoğun bakım ünitesinde yapılan cerrahi ve perkütan trakeostomilerin komplikasyonlar yönünden değerlendirilmesi. Turk J Anaesth Reanim. 2013;41:84-7.
  • 27. Bouderka MA, Fakhir B, Bouaggad A, Hmamouchi B, Hamoudi D, Harti A. Early tracheostomy versus prolonged endotracheal intubation in severe head injury. J Trauma Acute Care Surg. 2004;57(2):251-4.
  • 28. Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med. 2004;32(8):1689-94.

Percutaneous and Surgical Tracheostomy Experience in Intensive Care

Year 2020, Volume: 22 Issue: 2, 192 - 198, 31.08.2020

Dilek Destegül Fazilet Kocaöz Özlem Özkan Kuşcu

Abstract

Objective: The aim of the study is to evaluate the patients who underwent operational and percutaneous dilatational tracheostomy.
Material and Methods: The study was conducted at the Niğde Ömer Halisdemir University Training and Research Hospital. Patients who underwent tracheostomy procedure in the Intensive Care Unit between January 2015- December 2017 were assessed retrospectively. Demographic data of the patients, diagnosis, length of stay in the intensive care unit and hospital, entubation period before the tracheostomy procedure, duration of the procedure, early and late complications of tracheostomy, correlation of APACHE II score and survival rates were recorded. Patient data were retrieved from the hospital’s database retrospectively.
Results: There were 168 patients during the study period. 45.8%of patients (n=76) were female. Mean age of the patients was 65.61±18.42 years. Median of the APACHE II score was 29.83±6.92. The most common diagnosis was chronic obstructive pulmonary disease exacerbation (n=44, 26.2%). One hundred and six patients (75%) underwent percutaneous dilatational tracheostomy procedure. While perioperative major bleeding (n=2) was the complication of surgical tracheostomy; ventilation problems (n=4) and tracheoesophageal fistula (n=1) were the complications for percutaneous dilatational tracheostomy procedure. Entubation period before the tracheostomy procedure was shorter than 10 days only for 27 patients. The entubation period and length of intensive care unit stay and hospital stay were correlated (p<0.0001). There was no statistically difference for mortality rates between two groups (p=0.212).
Conclusion: In intensive care patients, percutaneous dilatational tracheostomy technique can be preferred as an alternative to surgical tracheostomy for elective tracheostomy. Early decision of tracheostomy contributes to shortening of the length of intensive care unit stay and hospital stay.

Keywords

Tracheostomy intensive care unit mortality

References

  • 1. Priest RE. LXXXI History of tracheotomy. Ann Otol, Rhinol & Laryngology. 1952;61(4):1039-45.
  • 2. Jackson C. Tracheotomy. The Laryngoscope. 1909;19(4):285-90.
  • 3. Galloway TC. Tracheotomy in bulbar poliomyelitis. JAMA. 1943;123(17):1096-97.
  • 4. Nelson-Jones A, Williams RH Hunt. Tracheotomy in bulbar poliomyelitis. The Lancet. 1945;245(6349):561-3.
  • 5. Ciaglia P, Firsching, R, Syniec C. Elective percutaneous dilatational tracheostomy: a new simple bedside procedure; preliminary report. Chest. 1985;87(6):715-19.
  • 6. Griggs WM, Myburgh JA, Worthley LIG. A prospective comparison of a percutaneous tracheostomy technique with standard surgical tracheostomy. Intens Care Med. 1991;17(5):261-63.
  • 7. Esteller-Moré E, Ibañez J, Matino E, Ademà JM, Nolla M & Quer IM. Prognostic factors in laryngotracheal injury following intubation and/or tracheotomy in ICU patients. Eur Arch Oto-Rhino-Laryngol Head & Neck. 2005;262(11):880-3.
  • 8. Friedman Y. Indications, timing, techniques, and complications of tracheostomy in the critically ill patient. Curr Opin Crit Care. 1996;2(1):47-53.
  • 9. Esteban A, Anzueto A, Alia I, Gordo F, Apezteguia C, Palizas F et al. How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Resp Crit Care Med. 2000;161(5):1450-58.
  • 10. Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB, Vivaldi, N. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. Jama. 2010;303(15):1483-89.
  • 11. Diehl JL, Atrous SE, Touchard D, Lemaire F, Brochard L. Changes in the work of breathing induced by tracheotomy in ventilator-dependent patients. Am J Resp Crit Care Med. 1999;159(2):383-8.
  • 12. Jaeger JM, Littlewood Keith A, Durbin Jr CG. The role of tracheostomy in weaning from mechanical ventilation. Resp Care. 2002;47(4):469-80.
  • 13. Nieszkowska A, Combes A, Luyt CE, Ksibi H, Trouillet JL, Gibert C et al. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med. 2005;33(11):2527-33.
  • 14. Freeman BD, Isabella KL, Buchman TG. A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest. 2000;118(5):1412-18.
  • 15. Antonelli M, Michetti V, Di Palma A, Conti G, Pennisi MA, Arcangeli A et al Percutaneous translaryngeal versus surgical tracheostomy: a randomized trial with 1-yr double-blind follow-up. Crit Care Med. 2005;33(5):1015-20.
  • 16. Friedman Y, Mizock BA. Percutaneous versus surgical tracheostomy: procedure of choice or choice of procedure. Crit Care Med. 1999;27(8):1684-85.
  • 17. Mirski MA, Pandian V, Bhatti N, Haut E, Feller-Kopman D, Morad A et al. Safety, efficiency, and cost-effectiveness of a multidisciplinary percutaneous tracheostomy program. Crit Care Med. 2012;40(6):1827-34.
  • 18. Vargas M, Sutherasan Y, Antonelli M, Brunetti I, Corcione A, Laffey JG et al. Tracheostomy procedures in the intensive care unit: an international survey. Crit Care. 2015;19:291.
  • 19. Hacı C, Açıkalın RM, Akkoç İ, Toptaş M. Perkütan ve cerrahi trakeostomilerin avantaj ve dezavantajlarının araştırılması. Mel Bul Haseki. 2018;56(1). Doi:10.4274/haseki.66375.
  • 20. Heikkinen M, Aarnio P, Hannukainen J. Percutaneous dilational tracheostomy or conventional surgical tracheostomy? Crit Care Med. 2000;28(5):1399-1402.
  • 21. Sağıroğlu AE, Ağkoç E, Doğan Y, Gömeçlioğlu V, Orhon Z, Yavaş C Yoğun bakım ünitesinde perkütan ve cerrahi trakeostominin karşılaştırılması. Göztepe Tıp Dergisi. 2010;25:67-70.
  • 22. Higgins KM, Punthakee X. Meta‐analysis comparison of open versus percutaneous tracheostomy. Laryngoscope. 2007;117(3):447-54.
  • 23. Putensen C, Theuerkauf N, Guenther U, Vargas M, Pelosi P. Percutaneous and surgical tracheostomy in critically ill adult patients: a meta-analysis. Crit Care Med. 2014;18(6):544.
  • 24. Silvester W, Goldsmith D, Uchino S, Bellomo R, Knight S, Seevanayagam S et al. Percutaneous versus surgical tracheostomy: a randomized controlled study with long-term follow-up. Crit Care Med. 2006;34(8):2145-52.
  • 25. Reed MF, Mathısen DJ. Tracheoesophageal fistula. Chest Surg Clin N Am. 2003;13(2):271-89.
  • 26. Düger C, İsbir AC, Uysal İÖ, Kol İÖ, Kaygusuz K, Gürsoy S et al. Yoğun bakım ünitesinde yapılan cerrahi ve perkütan trakeostomilerin komplikasyonlar yönünden değerlendirilmesi. Turk J Anaesth Reanim. 2013;41:84-7.
  • 27. Bouderka MA, Fakhir B, Bouaggad A, Hmamouchi B, Hamoudi D, Harti A. Early tracheostomy versus prolonged endotracheal intubation in severe head injury. J Trauma Acute Care Surg. 2004;57(2):251-4.
  • 28. Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med. 2004;32(8):1689-94.
There are 28 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Dilek Destegül 0000-0003-4363-6239

Fazilet Kocaöz This is me 0000-0002-5418-6707

Özlem Özkan Kuşcu 0000-0003-2252-4289

Publication Date August 31, 2020
Submission Date January 14, 2020
Published in Issue Year 2020 Volume: 22 Issue: 2

Cite

APA Destegül, D., Kocaöz, F., & Özkan Kuşcu, Ö. (2020). YOĞUN BAKIMDA PERKÜTAN VE CERRAHİ TRAKEOSTOMİ DENEYİMLERİMİZ. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 22(2), 192-198.
AMA Destegül D, Kocaöz F, Özkan Kuşcu Ö. YOĞUN BAKIMDA PERKÜTAN VE CERRAHİ TRAKEOSTOMİ DENEYİMLERİMİZ. Kırıkkale Uni Med J. August 2020;22(2):192-198.
Chicago Destegül, Dilek, Fazilet Kocaöz, and Özlem Özkan Kuşcu. “YOĞUN BAKIMDA PERKÜTAN VE CERRAHİ TRAKEOSTOMİ DENEYİMLERİMİZ”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 22, no. 2 (August 2020): 192-98.
EndNote Destegül D, Kocaöz F, Özkan Kuşcu Ö (August 1, 2020) YOĞUN BAKIMDA PERKÜTAN VE CERRAHİ TRAKEOSTOMİ DENEYİMLERİMİZ. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 22 2 192–198.
IEEE D. Destegül, F. Kocaöz, and Ö. Özkan Kuşcu, “YOĞUN BAKIMDA PERKÜTAN VE CERRAHİ TRAKEOSTOMİ DENEYİMLERİMİZ”, Kırıkkale Uni Med J, vol. 22, no. 2, pp. 192–198, 2020.
ISNAD Destegül, Dilek et al. “YOĞUN BAKIMDA PERKÜTAN VE CERRAHİ TRAKEOSTOMİ DENEYİMLERİMİZ”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 22/2 (August 2020), 192-198.
JAMA Destegül D, Kocaöz F, Özkan Kuşcu Ö. YOĞUN BAKIMDA PERKÜTAN VE CERRAHİ TRAKEOSTOMİ DENEYİMLERİMİZ. Kırıkkale Uni Med J. 2020;22:192–198.
MLA Destegül, Dilek et al. “YOĞUN BAKIMDA PERKÜTAN VE CERRAHİ TRAKEOSTOMİ DENEYİMLERİMİZ”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, vol. 22, no. 2, 2020, pp. 192-8.
Vancouver Destegül D, Kocaöz F, Özkan Kuşcu Ö. YOĞUN BAKIMDA PERKÜTAN VE CERRAHİ TRAKEOSTOMİ DENEYİMLERİMİZ. Kırıkkale Uni Med J. 2020;22(2):192-8.
 Download Cover Image

Bu Dergi, Kırıkkale Üniversitesi Tıp Fakültesi Yayınıdır.