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Titolo:
Posterior tracheal wall perforation during percutaneous dilational tracheostomy - An investigation into its mechanism and prevention
Autore:
Trottier, SJ; Hazard, PB; Sakabu, SA; Levine, JH; Troop, BR; Thompson, JA; McNary, R;
Indirizzi:
St41ouis Univ, St Johns Mercy Med Ctr, Dept Crit Care Med, St Louis, MO 631 St Louis Univ St Louis MO USA 63141 Dept Crit Care Med, St Louis, MO 631 Univ Tennessee, Ctr Hlth Sci, Med Educ & Res Inst, Memphis, TN 38163 USA Univ Tennessee Memphis TN USA 38163 duc & Res Inst, Memphis, TN 38163 USA Portex Inc, Smiths Ind Med Syst, Keene, NH USA Portex Inc Keene NH USAPortex Inc, Smiths Ind Med Syst, Keene, NH USA
Titolo Testata:
CHEST
fascicolo: 5, volume: 115, anno: 1999,
pagine: 1383 - 1389
SICI:
0012-3692(199905)115:5<1383:PTWPDP>2.0.ZU;2-1
Fonte:
ISI
Lingua:
ENG
Soggetto:
CRITICALLY ILL PATIENTS; DILATATIONAL TRACHEOSTOMY; PERIOPERATIVE COMPLICATIONS; BRONCHOSCOPIC GUIDANCE; BEDSIDE PROCEDURE; TRACHEOTOMY; VENTILATION; SAFE;
Keywords:
complications; critically ill; fiberoptic bronchoscopy; guiding catheter; percutaneous dilational tracheostomy; posterior tracheal wall injury; posterior tracheal wall perforation;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
29
Recensione:
Indirizzi per estratti:
Indirizzo: Trottier, SJ St Louis Univ, St Johns Mercy Med Ctr, Dept Crit Care Med, Tower B 5007,621 St Louis Univ Tower B 5007,621 S New Ballas Rd St Louis MO USA 63141
Citazione:
S.J. Trottier et al., "Posterior tracheal wall perforation during percutaneous dilational tracheostomy - An investigation into its mechanism and prevention", CHEST, 115(5), 1999, pp. 1383-1389

Abstract

Objectives: Part 1: To describe the complication of posterior tracheal wall injury and perforation associated with the pel cutaneous dilational tracheostomy (PDT). Part 2: To determine the mechanism of posterior tracheal wall injury during PDT,Design: Prospective observational study. Subjects: Pall. 1: Medical-surgical ICU patients requiring tracheostomy. Part 2: Swine and cadaver models,Interventions: Part 1: Consecutive medical-surgical ICU patients undergoing tracheostomy tube insertion via the percutaneous dilation technique with bronchoscopic guidance were enrolled in the study, Demographic data and complications were recorded, Part 2: Tracheostomy tubes were inserted via the percutaneous dilational technique in the swine model with concomitant bronchoscopic video recording from the proximal and distal airways, Tracheostomytubes were inserted via the percutaneous dilational technique in the cadaver model followed by anatomic inspection of the airway,Results: Part 1: Seven (29%) of 2 1 medical-surgical ICU patients sustained complications associated with PDT, Three patients (12.5%) sustained posterior tracheal wall perforations followed by the development of tension pneumothoraces, Part 2: The swine model demonstrated that posterior tracheal wall perforation may occur during PDT when the guiding catheter is withdrawn into the dilating catheters, Five-centimeter posterior tracheal wall mucosal lacerations occurred when the guidewire and the guiding catheter were notproperly stabilized during PDT,Conclusion: Percutaneous dilational tracheostomy was associated with a 29%complication rate in this observational study. Of concern was the high rate (12.5%) of posterior tracheal wall perforation. The swine and cadaver models suggest that posterior tracheal mall injury or perforation may occur ifthe guidewire and guiding catheter are not properly stabilized. To avoid posterior tracheal wall injury, the guidewire and guiding catheter should befirmly stabilized during PDT.

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Documento generato il 05/12/20 alle ore 07:53:51