Abstract
Objective: to clarify the safety, benefits and common techniques of percutaneous dilatational tracheostomy (PDT).
Material and methods: 62 patients in the RSCS and 14 patients in resuscitation on the road in other hospitals were performed PDT from 2007 to 2012y. All patients were on prolonged mechanical ventilation due to different severe complications. We use Ciaglia's techniques for PDT. This Seldinger-based technique involves cannulation of trachea between 1st & 2nd or 2nd & 3rd tracheal ring with a guide wire. This is followed by graded dilatation of the trachea using multiple dilators.
Results: Duration of PDT in the initial stages was 12-30 minutes, after acquiring enough experience, it fell to 7-10 min. Minor bleeding from small vessels that do not pose a threat and quickly eliminated by coagulation were observed in 8 (12.9%) patients. In 6 (9.7%) patients had inflammatory changes in the tracheostomy tube. In 2 (3.2%) cases were observed delamination of tracheal mucosa. And only in 2 (3.2%) cases were observed posttraheostomic tracheal stenosis which in tracitional tracheostomy observes on 16-64% cases. In conventional tracheostomy posttraheostomic complication as tracheoesophageal fistula (3-7%) subsequently require reconstructive surgery. It should be noted, that the advantages of the procedure PDT Ciaglia over conventional tracheostomy procedure is - the speed of the procedure; minimally invasive techniques; low rate of various complications.
CONCLUSIONS: PDT is minimally invasive, less traumatic and is reasonably safe. Our experience allows to recommend PDT as an alternative to conventional tracheostomy in patients on prolonged mechanical ventilation with forecasting long-term respiratory support hardware.
- © 2014 ERS
