ISSN: 1305-9327

 
 

VOLUME: 13 NUMBER: 4
 
 

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Print version of Medical Journal of Bakirkoy has been stopped as of 2018; the journal continues to be published as e-journal starting with March 2018 issue.

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3 - Evaluation of late term complications dilatation tracheostomy of intensive care unit
   
Yasemin Tekdöş Şeker, Evrim Kucur Tülübaş, Oya Hergünsel, Zafer Çukurova
   
  ABSTRACT
   
  Objective: The tracheostomy process is used in current intensive care units due to the increasing sedation required to enhance endotracheal tube tolerance, reducing physiological dead space, cleaning bronchoalveolar secretion and separating it from mechanical ventilation. Both due to low cost and late-term realization of the operation, bedside percutaneous dilatation tracheotomies should be included further in daily practice. The tracheostomy can also be performed by using surgical techniques. “Ciaglia Blue Rhino (Single Dilatation)”, Percutwist (Controlled Dilatation), Griggs (Forceps Dilatation), Fantoni Translaringeal are most common tracheostomy methods. In this study, we aimed to retrospectively compare late complications of surgical and percutaneous tracheotomies performed in a research and training hospital’s intensive care unit.

Material and Method: In this study, 303 cases that tracheostomy performed with various indications from May 2012 to December 2015, in a research and training hospital intensive care unit, retrospectively examined. 12 patients who can not be reached after discharge were excluded from the study. 291 of the tracheostomy cases’ opening methods, either surgical or percutaneous, the period spent under tracheostomy, and late-term complications were evaluated by using patient charts. A standard monitorization was implemented for all cases, and the procedures were performed under general anesthesia. The forceps dilatation (Griggs) method was used in all percutaneous cases. The airway was penetrated through 2-3 tracheal rings with a needle with the guide wire being guided to the airway. Cutaneous and subcutaneous incisions were performed on the edges of the wire. The cutaneous and subcutaneous areas were expanded with a dilatator by using the Seldinger method. By means of a ‘Howard-Kelly’ forceps guide wire, a dilatation where cannula may be placed at cutaneous-subcutaneous tissues and tracheal membrane cannula via guide wire was performed. The cannula was placed and fixed with neckties. The surgical interventions were implemented by an otorhinolaryngology expert, under surgery room conditions.

Results: Among the 291 cases followed in intensive care unit with various indications. The youngest case was 10 while the oldest case was 95 years old. The Tracheostomy period in the intensive care unit was minimum 9 days and maximum 300 days, and it was 33.89±19.83 days on average. Tracheotomies were performed using the percutaneous method in 255 cases. Any losses of cases due to the complications of the process were not experienced during or after the tracheostomy. 166 of cases were lost for other reasons which are irrelevant to the tracheostomy process. The tracheoesophageal fistula was identified in 15 cases during the late term. Tracheal stenosis was identified after decannulation in 5 cases. Other complications caused by a tracheostomy were not reported during the long-term follow-ups of the 125 live cases.

Discussion: Tracheada granulation tissue, tracheal stenosis, tracheasofagial and tracheocutaneous fistula may be encountered in the late period complications of tracheostomy. Stenosis has been noted stomally or substromally immediately under the vocal chords in general. Sepsis, stromal infection, senility, large scale cannula use, extreme canula movement, tightly fit canula, extended decanulation, extreme issuance of anterior cartilage in surgical technique are risk factors.

Conclusion: We believe that the percutenous tracheostomy method is superior to a surgical tracheostomy due to lower cost and risk of complication.
   
  Keywords
  Late complications, percutaneous dilatation tracheostomy
   
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