ABSTRACT
Objective:To investigate the value of flexible bronchoscopy and neck ultrasound in percutaneous dilatational tracheotomy (PDT) in infants.Methods:The clinical data of 24 patients, who underwent flexible bronchoscopy and neck ultrasound assisted PDT in the Center for Respiratory Intervention, Children′s Hospital Affiliated to Shandong University from December 2018 to May 2021, were retrospectively analyzed.Of the 24 cases, 12 were male and 12 female.The male to female ratio was 1∶1.The age range was 21 days to 2 years (median: 5 months). The median mass was 5.8 kg.During the PDT, neck ultrasound was used to assess the thyroid position and vascular shape of vessels.After determining the puncture approach and marking the tracheostomy site, the PDT was performed under the guidance of flexible bronchoscopy.Results:Before surgery, 19 children (79.2%) had received continuous endotracheal intubation mechanical ventilation support, 2 children (8.3%) were treated by intermittent endotracheal intubation mechanical ventilation support therapy, and 3 children (12.5%) were supported by the non-invasive ventilator.There were 9 cases (37.5%) of congenital upper respiratory tract malformation, 8 cases (33.3%) of bilateral vocal cord paralysis, 3 cases (12.5%) of upper respiratory tract neoplastic diseases, 2 cases (8.3%) of surgical evacuation difficulties, and 2 cases (8.3%) of neuromuscular disease.All 24 patients successfully completed the operation within 30 min, with bleeding volume less than 5 mL and no intraoperative complications.Conclusions:Flexible bronchoscopy and neck ultrasound can assist in the successful PDT in infants, significantly reduce the difficulty and improve the safety of PDT.
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Objective To investigate the effect of preoperative percutaneous dilatational trache-otomy (PDT)in oral and maxillofacial surgery anesthesia versus traditional surgical tracheotomy (ST).Methods General data,vital signs,operation time,anesthetics,the amount of bleeding and complications during the procedure were analyzed after reviewing the clinical data of 124 cases under-going radical correction of oral and maxillofacial tumor plus flap transferring and repairing and trache-otomy during May 2013 to May 201 5.Results A total of 124 cases were divided into two groups:PDT group (group P,n =41)and ST group (group S,n =83).There was no significant difference of general data between the two groups.The incision length and operation time were significantly shorter and the amount of bleeding was remarkably lower in group P than those in group S (P <0.05),while the incidence of complications was not significantly different between the two groups.Conclusion PDT has more advantages over traditional ST and is a better airway approach in oral and maxillofacial surgery.
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OBJECTIVE:Procalcitonin is a reliable biomarker of infection and sepsis. We aimed to determine whether tracheotomy influences the procalcitonin concentrations in patients without sepsis and assess whether operative duration and procedure affect the peak procalcitonin level.METHODS:A total of 38 non-septic patients who required a tracheotomy underwent either a percutaneous dilatational tracheotomy (n=19) or a surgical tracheotomy (n=19). Procalcitonin levels were measured at the beginning of the tracheotomy and at 2 h, 4 h, 8 h, 24 h, 48 h and 72 h after the procedure.RESULTS:The baseline procalcitonin concentration before the tracheotomy was 0.24±0.13 ng/mL. The postoperative levels increased rapidly, with a 4-fold elevation after 2 h, reaching a peak 4 h later with a 5-fold increase over baseline. Thereafter, the levels gradually returned to 2-fold greater than the baseline level within 72 h. The peak levels of procalcitonin showed a significant positive correlation with operative durations (r=0.710, p<0.001) and procedures (rho=0.670, p<0.001).CONCLUSION:In patients without sepsis, tracheotomy induces a rapid release of serum procalcitonin, and the operative duration and procedure have significant impacts on the peak procalcitonin levels. Thus, the nonspecific increase in procalcitonin levels following tracheotomy needs to be considered when this measure is used to evaluate infection.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Calcitonin/blood , Protein Precursors/blood , Sepsis/blood , Tracheotomy , Biomarkers/blood , Electrochemical Techniques , Luminescent Measurements , Operative Time , Prospective Studies , Time FactorsABSTRACT
Objective To discuss the value of percutaneous dilatational tracheotomy(PDT) for cardiosurgery in intensive care unit by comparing its outcomes with that of open tracheotomy(OT).MethodsA prospective study was conducted on 40 severe patients undergoing cardiosurgery.The patients were divided into PDT(treated from January 2002 to July 2003) and OT groups(treated from August 2003 to February 2008) with 20 cases in each.The operation time,length and heal time of the incision,blood loss,vital signs,and postoperative complications were compared between the two groups.ResultsThe operation time,length and heal time of the incision in the PDT group were significantly different from that in the OT group [(8.8?2.2) min vs(21.5?5.3) min,t=-9.897;(1.3?0.2) cm vs(3.4?0.5) cm,t=-17.440;and(3.9?0.9) d vs(5.9?1.2) d,t=-5.963;P=0.000].One patient in the PDT group(5%) had Ⅱ degree blood loss during the operation that was significantly less than those in the OT group(13 patients,65%,?2=15.824,P=0.000).The level of the vital signs change in the PDT group was significantly milder than those in the OT group [MAP: 1-5 mm Hg(median 2) vs 1-20 mm Hg(median 3.5),Z=-2.959,P=0.003;heart rate: 3-12 beats/min(median 5.5) vs 7-70 beats/min(median 10),Z=-3.956,P=0.000;SpO2: 0-4%(median 2%) vs 0-31%(median 3.5%),Z=-3.548,P=0.000].Furthermore,the rate of incisional leakage of sputum and overall rate of complications in the PDT group were significantly lower than those in the OT group.[1(5%) vs 8(40%),?2=5.161,P=0.023;and 1(5%) vs 12(60%),?2=13.789,P=0.000].ConclusionsPDT is a safe and minimally invasive technique with a high rate of success and low rate of complications.The method is easy to operate,and thus could be a good choice for severe patients after cardiovascular surgeries.