GKD Anest Yoð Bak Dern Derg. 2022; 28(2): 158-163 | DOI: 10.14744/GKDAD.2022.94899

Yoðun Bakým Ünitelerimizde Perkütan Dilatasyonel Trakeostomi Uygulamalarýmýz: 10 Yýllýk Retrospektif Çalýþma

Þule Batçýk, Tolga Koyuncu
Recep Tayyip Erdoðan Üniversitesi Týp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalý, Rize, Türkiye

Amaç: Perkütan dilatasyonel trakeostomi, yoðun bakým ünitelerinde yaygýn olarak kullanýlmakta olan giriþimsel bir iþlemdir. Komplikasyon oranlarý düþük olan bu uygulama hasta konforunu artýrýr ve hava yolu yönetimini kolaylaþtýrýr. Ancak iþlem sýrasýnda ve sonrasýnda erken ve geç dönem komplikasyonlar görülebilmektedir. Çalýþmanýn amacý, 10 yýllýk süre içinde yoðun bakým ünitesinde uygulanan perkütan dilatasyonel trakeostomi giriþimlerinin klinik deðerlendirmesinin yapýlmasýdýr.
Yöntem: Çalýþmamýza 2010-2020 yýllarý arasýnda cerrahi yoðun bakým ünitesinde ve anestezi yoðun bakým ünitesinde yatan ve perkütan dilatasyonel trakeostomi açýlmýþ 18 yaþ üstü 275 hasta dahil edildi. Hastalarýn yaþý, cinsiyeti, yatýþ tanýlarý, komorbid hastalýklarý, APACHE-II ve Glasgow koma skoru puanlarý, yatýþ ve taburculuk tarihleri, trakeostomi açýlma tarihleri, iþlem sýrasýnda ve sonrasýnda karþýlaþýlan erken ve geç dönem komplikasyonlar, dekanülasyon, nakil ve mortalite durumlarý retrospektif olarak tarandý.
Bulgular: Hastalarýn yaþ ortalamasý 71,6±14,6 yýl olarak tespit edildi. Yoðun bakým ünitesi yatýþ günlerine ait APACHE-II puanlarý 23,3±7,6 ve Glasgow koma skoru puanlarý 7,5±3,5 idi. En yüksek mortalite (%22) iskemik veya hemorajik serebral hasar grubunda idi. Yoðun bakým ünitesinde mekanik ventilasyonda geçirilen süre 34,2±19,4; yoðun bakým ünitesinde geçirilen süre 37,2±20,5 gün olarak belirlendi. Trakeostomi açýlma zamaný 16,3±7,7 gün olarak bulundu. Hastalarýn %33’üne erken (≤10 gün), %67’sine geç (>10 gün) dönemde perkütan dilatasyonel trakeostomi açýldý. Ýki yüz yetmiþ beþ hastanýn 27’sinde (%9,8) komplikasyon geliþti. En sýk görülen komplikasyonu kanama oluþturdu (%4,4). Sonuç: Perkütan dilatasyonel trakeostomi düþük komplikasyon oranlarý nedeniyle güvenli bir uygulamadýr. Ancak yoðun bakým ünitelerinde farklý uygulamalarda sýklýkla kullanýlan fiberoptik bronkoskopi ve ultrasonografinin perkütan dilatasyonel trakeostomi uygulamalarýnda da komplikasyonlarý azaltmada etkili olabileceðini düþünmekteyiz.

Anahtar Kelimeler: Komplikasyon, perkütan dilatasyonel trakeostomi, yoðun bakým ünitesi

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Percutaneous Dilatational Tracheostomy Applicatýons in Our Intensive Care Units: A 10-Year Retrospective Study

Þule Batçýk, Tolga Koyuncu
Department of Department of Anaesthesiology and Reanimation, Recep Tayyip Erdoðan University Faculty of Medicine, Rize, Türkiye

Objectives: Percutaneous dilatational tracheostomy (PDT) is an interventional procedure that is widely used in intensive care units (ICUs). This application, which has low complication rates, increases patient comfort and facilitates airway management. However, early and late complications can be seen during and after the procedure. The objective of this study was to perform the clinical evaluation of PDT interventions applied in the ICU over a 10-year period.
Methods: A total of 275 patients over the age of 18 who were hospitalized in the Surgical ICU and Anesthesia ICU and underwent PDT between 2010 and 2020 were included in the study. Patients’ age, gender, diagnosis of hospitalization, comorbid diseases, APACHE-II and Glasgow Coma Scale (GCS) scores, hospitalization and discharge dates, time to open tracheostomy, early and late complications encountered during and after the procedure, decannulation, transplantation, and mortality were retrospectively reviewed.
Results: The mean age of the patients was 71.6±14.6 years. During ICU admission, APACHE II scores were 23.3±7.6 and GCS scores were 7.5±3.5. The highest mortality (22%) was in the ischemic or hemorrhagic cerebral injury group. The duration of mechanical ventilation in the ICU was 34.2±19.4 days, and the length of stay in the ICU was 37.2±20.5 days. Time to open a tracheostomy was found as 16.3±7.7 days. PDT was performed in the early (≤10 days) period in 33% of the patients, and in the late (>10 days) period in 67% of the patients. Twenty-seven (9.8%) of the 275 patients develop complications with bleeding being the most commonly seen complication by 4.4%.
Conclusion: PDT is a safe procedure due to its low complication rates. However, we think that fiber optic bronchoscopy and ultrasonography, which are frequently used in different applications in ICUs, may also be effective in reducing complications in PDT applications.

Keywords: Complication, intensive care unit, percutaneous dilatational tracheostomy

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