ABSTRACT
OBJECTIVE: To review and compare the complications of percutaneous tracheotomy (TP) and cricothyroidotomy (CT) used to perform tracheal intubation in patients requiring prolonged mechanical ventilation. DESIGN: A prospective, observational study performed from October 2004 to October 2006, and follow-up of course until May 2007. SETTING: Intensive care service from a university-affiliated teaching hospital. PATIENTS: A total of 82 patients in which CT or TP were necessary. Forty-three TP and 39 CT were performed. MAIN MEASUREMENTS: Reason for TP or CT, demographic data, severity scores, ICU length of stay, orotracheal intubation (OTI) days, CT/TP early and late complications and in-hospital evolution were collected. RESULTS: TP/CT were performed due to prolonged ventilation in 62 (76%) patients and because of impaired neurological status in the remaining patients. There were no differences between TP/CT in gender, APACHE II, ICU length of stay, previous OTI days. Patients in the CT group were older (68 +/- 9 vs 54 +/- 15 years, p < 0.001). There were 5 mild adverse events (3 guide angulations and 2 lateral tracheal punctions) after TP, and 1 severe adverse event (pulmonary ventilation problem) after CT. There were no fatal event related with TP/CT. Thirty-four patients were decanulated. Mild local injuries were seen in 8 patients (6 TP vs 2 CT). Only 1 subglottic granuloma was seen late in CT group. CONCLUSIONS: In our experience CT constitutes a safety and feasible alternative to TP when TP is counter-indicated.
Subject(s)
Critical Illness , Intubation, Intratracheal/methods , Tracheotomy/adverse effects , Tracheotomy/methods , Aged , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
Objetivo. Revisar y comparar las complicaciones de las traqueotomías percutáneas (TP) y las coniotomías por disección (CT) como métodos de canulación subglótica de la vía aérea. Diseño. Estudio prospectivo y observacional, desde octubre de 2004 a octubre de 2006 y seguimiento de la evolución hasta mayo de 2007. Ámbito. Servicio de medicina intensiva (SMI) de un hospital universitario. Pacientes. 82 pacientes a los que se realizó canulación subglótica mediante TP (42 casos) o CT (39 casos). Variables de interés. Motivo para la canulación subglótica, datos demograficos, gravedad, días de hospitalización en el SMI, días de intubación orotraqueal (IOT), problemas inmediatos y tardíos, evolución. Resultados. Fueron canulados por ventilación prolongada 62 (76%) pacientes y por depresión neurológica, el resto. No hubo diferencias entre TP y CT en el sexo, la gravedad de la enfermedad medida por APACHE II, los días de estancia en SMI y los días de IOT previos a la realización de la canulación subglótica. Los pacientes del grupo CT tuvieron más edad (68 ± 9 frente a 54 ± 15 años; p < 0,001). Hubo 5 pacientes en el grupo TP con problemas leves (3 por angulación del fiador y 2 por punción traqueal lateral). Hubo 1 caso en el grupo CT con dificultad en la ventilación pulmonar durante el procedimiento. No hubo ningún fallecimiento relacionado con la TP o la CT. Fueron descanulados 34 pacientes; en 8 casos (6 TP y 2 CT) se objetivaron lesiones leves sin repercusión clínica. Se produjo un granuloma subglótico de forma tardía en un paciente con CT. Conclusiones. En nuestra experiencia la CT es una alternativa a la TP cuando ésta no está indicada (AU)
Objective. To review and compare the complications of percutaneous tracheotomy (TP) and cricothyroidotomy (CT) used to perform tracheal intubation in patients requiring prolonged mechanical ventilation. Design. A prospective, observational study performed from October 2004 to October 2006, and follow-up of course until May 2007. Setting. Intensive care service from a university-affiliated teaching hospital. Patients. A total of 82 patients in which CT or TP were necessary. Forty-three TP and 39 CT were performed. Main measurements. Reason for TP or CT, demographic data, severity scores, ICU length of stay, orotracheal intubation (OTI) days, CT/TP early and late complications and in-hospital evolution were collected. Results. TP/CT were performed due to prolonged ventilation in 62 (76%) patients and because of impaired neurological status in the remaining patients. There were no differences between TP/CT in gender, APACHE II, ICU length of stay, previous OTI days. Patients in the CT group were older (68 ± 9 vs 54 ± 15 years, p < 0.001). There were 5 mild adverse events (3 guide angulations and 2 lateral tracheal punctions) after TP, and 1 severe adverse event (pulmonary ventilation problem) after CT. There were no fatal event related with TP/CT. Thirty-four patients were decanulated. Mild local injuries were seen in 8 patients (6 TP vs 2 CT). Only 1 subglottic granuloma was seen late in CT group. Conclusions. In our experience CT constitutes a safety and feasible alternative to TP when TP is counter-indicated (AU)
Subject(s)
Humans , Tracheostomy/methods , Catheterization/methods , Intubation, Intratracheal/methods , Prospective Studies , Critical Illness/therapy , Airway Obstruction/therapySubject(s)
Candidiasis , Endocarditis/microbiology , Tricuspid Valve , Fatal Outcome , Female , Humans , Middle AgedABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Endocarditis, Bacterial , Candida albicans/pathogenicity , Tricuspid Valve Insufficiency/etiology , Candidiasis/complicationsSubject(s)
Brain Abscess/microbiology , Cerebral Ventricles/microbiology , Salmonella Infections/complications , Salmonella enteritidis/isolation & purification , Brain Abscess/cerebrospinal fluid , Brain Abscess/diagnostic imaging , Female , Humans , Middle Aged , Salmonella Infections/cerebrospinal fluid , Tomography, X-Ray ComputedABSTRACT
No disponible
