Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Ultrasonografi Eşliğinde Açılan Perkütan Trakeostomi ile Fiberoptik Bronkoskopi Eşliğinde Açılan Perkütan Trakeostominin Karşılaştırılması: Klinik Deneysel Araştırma
The Comparison of Ultrasonography-Guided Percutaneous Tracheostomy with Fiberoptic Bronchoscopy-Guided Percutaneous Tracheostomy: Clinical Experimental Research
Ümran KARACAa, Tuğba ONURa, Şermin EMİNOĞLUa, Şeyda Efsun ÖZGÜNAYa, Filiz ATAa
aSağlık Bilimleri Üniversitesi Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Bölümü, Bursa, Türkiye
Turkiye Klinikleri J Anest Reanim. 2022;20(1):16-22
doi: 10.5336/anesthe.2021-86139
Article Language: TR
Full Text
ÖZET
 Amaç: Çalışmamızın amacı, ultrasonografi kullanılarak (USG) açılan perkütan dilatasyonel trakeostomi (PDT) ile fiberoptik bronkoskopi kullanarak (FOB) açılan PDT'nin işlem süresi ve komplikasyonlarını karşılaştırmaktır. Gereç ve Yöntemler: Çalışmamıza uzun süreli mekanik ventilasyon ihtiyacı olan erişkin hastalar dâhil edildi. Hastalar, USG ile açılan PDT (Grup I, n=30) ve FOB ile açılan PDT (Grup II, n=30) olarak prospektif, randomize olarak 2 gruba ayrıldı. Tüm hastaların demografik verileri ile birlikte yoğun bakıma yatış nedeni, hemogram, kan gazı değerleri, trakeostomi açılma süresi, işlem sırasında ve sonrasındaki komplikasyonları kaydedildi. Bulgular: Çalışmamızda, USG veya FOB yöntemi ile otuzar olmak üzere toplam 60 hastaya PDT açıldı. Gruplar arası trakeostomi açılma süresinde fark gözlenmedi (p=0,883). Her iki grup içi SpO2 değerlerindeki düşüş istatistiksel olarak anlamlıydı (sırasıyla p=0,004 p=0,002). Grup içinde PaO2 değerlerindeki düşüş istatistiksel olarak anlamlıydı (sırasıyla p=0,006, p=0,011). Trakeostomi için en yaygın endikasyon nörolojik hastalıklardı (Grup I: %36,7, Grup II: %43,3), ardından solunum sistemi ve multi travma hastalarına PDT açıldı. İşlem sonrası komplikasyon olarak en fazla minör kanama (Grup I: %13,3, Grup II: %10) görüldü. Stoma çevresinde kanama bunu takip etti (Grup I: %10, Grup II: %10). Sonuç: USG rehberliğinde ve bronkoskopi eşliğinde PDT açılması, havayolu yönetiminde hızlı ve güvenilir yöntemlerdir. Yöntem tercihi klinisyenin deneyimi ve kliniğin imkânlarına göre belirlenebilir.

Anahtar Kelimeler: Ultrasonografi; trakeostomi; bronkoskopi
ABSTRACT
 Objective: The aim of our study is to compare the procedural time and complications of ultrasonography (USG) guided percutaneous dilatational tracheostomy (PDT) with fiberoptic bronchoscopy (FOB) guided PDT. Material and Methods: Adult patients, required long-term mechanical ventilation were included in our study. Patients were prospectively, randomly assigned into 2 groups as PDT with USG (Group I, n=30), and PDT with FOB (Group II, n=30). Patients' demographic datas, the reason for admission to intensive care unit, hemogram, blood gas values, tracheostomy opening time, complications during and after the procedure were recorded. Results: A total of 60 adult patients were included in the study, 30 patients in USG group and 30 patients in FOB group. There was no difference in tracheostomy opening time between the groups (p=0.883). The decreases in SpO2 values within the group were statistically significant in both groups (p=0.004, p=0.002, respectively). The decreases in PaO2 values within the group were statistically significant (p=0.006, p=0.011, respectively). The most common indication for tracheostomy was neurological diseases (Group I: 36.7%, Group II: 43.3%), followed by PDT in respiratory system and multi-trauma patients. The most common postoperative complication was minor bleeding (Group I: 13.3%, Group II: 10%). Bleeding around the stoma was the second common complication (Group I: 10%, Group II: 10%). Conclusion: Ultrasoundguided and bronchoscopy-guided PDT are fast and reliable methods in airway management. The choice of method can be determined according to the clinician's experience and the clinic's facilities.

Keywords: Ultrasonography; tracheostomy; bronchoscopy
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