Rol de la traqueotomía percutánea en medicina intensiva: experiencia de 106 casos en Chile / Role of the percutaneous tracheostomy in intensive medicine: experience of 106 cases in Chile

RESUMEN

Aim: We our experience at ICU, Hospital Dr. G. Fricke, Viña del Mar, Chile in 106 procedures on 104 patients of percutaneous dilatational tracheostomy with Ciaglia P technique (TPD) and compared results with literature. Study Design: prospective observational study on adult critically ill population. Patients and methods: between February 1995 and December 2001 we perform at bedside 106 TPD on 104 patients admitted to mechanical ventilation, 36,7 percent for neurological causes, 18 percent for severe pneumonia, 12.26 percent for pulmonary edema and ARDS, 11.3 percent for sepsis and 10.3 percent for descompensated COPD, using a protocol for conversion that consider eary tracheotomy (before 48 Hrs) in neurological cases assumed long-term ventilation, and delayed tracheostomy (>10 days) in patients assumed short-term mechanical ventilation when weaning fails at the 10 day. Results: 9/106 cases (8.5 percent) presented procedure complications, minor bleeding in 7.6 percent and 1 case (0.94 percent) case had a false acceses because of severe deformation due to xifoescoliosis. 6/106 cases (5.6 percent) presented hypotension due to anesthetic drug that requiered treatment. Global complication rate was 15/106 (14 percent) lower than surgical tracheostomy rates (66 percen). There was no mortality related to procedure. Conclusions: TPD is an alternative probably superior to surgical tracheostomy, in our experience good knowledge of technique and adequate selection of patients is clue to avoid complications