Gómez CG, Valencia SVD, Lezama UCA, Álvarez SLM, Arellano JL, Careaga RG

Language: Spanish
References: 14
Page: 45-48
PDF size: 101.45 Kb.

ABSTRACT

Objective: To present our experience with the use of percutaneous tracheostomy in patients requiring prolonged mechanical ventilatory support after cardiac surgery.
Setting: General Hospital “Dr. Gaudencio González Garza”, Centro Médico Nacional “La Raza”, IMSS.
Design: Observational, descriptive, transversal, retrospective study.
Statistical analysis: Percentages as summary measure for qualitative variables.
Material and methods: We present the patients that required percutaneous tracheostomy between February 2007 and January 31, 2009. We revised indications and contraindications for the procedure. The used surgical technique consisted of a 1-cm transversal skin incision at the level of the 2nd tracheal ring, dissection, tracheal puncture, dilatation and tracheal cannula implantation. The presence of arrhythmia, loss of air ways, ‹ 90% desaturation, false pathway or tracheal lesion, hypotension, hemorrhage and its magnitude, need to convert the procedure, wound infection, pneumothorax, decannulation, subcutaneous emphysema, and death were monitored and recorded.
Results: Percutaneous tracheostomy was performed in 27 patients requiring prolonged mechanical ventilator support. There were 18 men and 8 women, average age of 56.1 ± 10.5 years (range from 38 to 73 years). Surgical time was of 12 ± 2.4 min. Hemorrhage was mild (‹ 30 ml). Neither morbidity, according to the analyzed variables, nor mortality, derived from the procedure, was observed. Seven patients died due to the background pathology.
Conclusion: Percutaneous tracheostomy is a safe and efficient option in patients requiring prolonged mechanical ventilatory support after cardiac surgery.

REFERENCES

1. Careaga-Reyna G, Martínez-Carballo G, Liliana María Anza-Costabile LM, Ávila-Funés A. Euroscore para predecir morbimortalidad en cirugía cardiaca valvular. Cir Ciruj 2008; 76: 497-505.

2. Celedón C, Walker KJ, Naser A, Neumann P, Nazar S. Traqueostomía abierta vs traqueostomía percutánea. Rev Otorrinolaringol Cir Cabeza Cuello 2007; 67: 222-228.

3. Ramírez-Hernández VM, González-Hernández MA, Osorio-Suárez CE, Garibay-González F. Traqueostomía percutánea: experiencia en la terapia intensiva del Hospital Militar Regional de Irapuato, Guanajuato. Rev Sanid Milit 2005; 59: 348-359.

4. Fajardo R, Pulido H, Henao F. Traqueostomía percutánea. Rev Colomb Cir 1999; 14: 76-80.

5. Madero-Pérez J, Vidal-Tegedor B, Abizanda-Campos R, Cubedo-Bort M, Alvaro-Sánchez R, Mico-Gómez M. Traqueostomía percutánea en pacientes ventilados. Med Intensiva 2007; 31: 120-125.

6. Griffiths J, Barber V, Morgan L, Young D. Systematic review and meta-analysis of studies of timing of tracheostomy in adult patients undergoing artificial ventilation. Br Med J 2005; 330: 1243-7.

7. Heffner JE. Tracheotomy: Indications and timing. Respir Care 1999, 44: 807-15.

8. Colice GL, Stukel TA, Dain B. Laryngeal complications of prolonged intubation. Chest 1989, 98: 877-84.

9. Frost EAM. Tracing the tracheostomy. Ann Otol 1976; 85: 618-24.

10. Jackson C. Tracheostomy. Laryngoscope 1909; 19: 285-90.

11. Dulguerov P, Gysin C, Perneger TV, Chevrolet JC. Percutaneous or surgical tracheostomy: a meta-analysis. Crit Care Med 1999; 27: 1617-25.

12. Freeman BD, Isabella K, Lin N, Buchman TG. A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest 2000; 118: 1412-18.

13. Massick D, Yao S, Powell D, Griesen D. Bedside tracheostomy in the intensive Care Unit: A prospective randomized trial comparing open surgical tracheostomy with endoscopically guided percutaneous dilational tracheotomy. Laryngoscope 2001; 111: 494-500.

14. Ayoub MO, Griffiths MV. Aortic arch laceration: a lethal complicaction after percutaneous tracheostomy. Laryngoscope 2007; 117: 176-8.