科研之友
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摘要
background: tracheostomy is a procedure commonly requiredin the intensive care unit. in the last two decades, the use of the percutaneous method has increased in parallel with improvements in the technique. objective: to describe our experience in employing the percutaneous method over the last 3.5 years. methods: we created, retrospectively, a database of prospective tracheostomy data related to 78 patients evaluated between january 2000 and july 2003. we used the percutaneous tracheostomy techniques of either progressive dilatation (in 36 patients) or forceps dilatation (in 42 patients). data are expressed as number of occurrences or median with interquartile ranges. results: the mean age of the patients was 66 (range, 43-75), and the median apache ii score was 16 (range, 12-21). the median time spent on mechanical ventilation prior to tracheostomy was 14 days (range, 10-17 days). of the 78 patients studied, 18 (23%) died while in the intensive care unit. the most common cause of admission was acute central nervous system disturbance (in 45%). most of the tracheostomies performed were indicated due to difficulty in weaning from mechanical ventilation (in 50%) or to glasgow coma scores consistently lower than 8 (in 49%). bronchoscopy was used in all but 6 of the procedures. there were complications in 33% of the procedures. the most common complication was light bleeding, without need for transfusion. no patient died due to complications arising from the procedure. conclusion: percutaneous tracheostomy is reasonable and safe when performed in an intensive care unit.
