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Korean J Crit Care Med > Volume 26(4); 2011 > Article
Korean Journal of Critical Care Medicine 2011;26(4): 261-266. doi: https://doi.org/10.4266/kjccm.2011.26.4.261
내과계 중환자실 전담의에 의해 시행된 경피적 확장 기관절개술의 안정성 및 유용성
유홍석ㆍ임소연ㆍ박치민*ㆍ서지영ㆍ전경만
성균관대학교 의과대학 내과학교실 삼성서울병원 호흡기내과, *외과학교실 삼성서울병원 외과
Safety and Feasibility of Percutaneous Tracheostomy Performed by Medical Intensivists
Hongseok Yoo, So Yeon Lim, Chi Min Park, Gee Young Suh, Kyeongman Jeon
1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. kjeon@skku.edu
2Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
ABSTRACT
BACKGROUND: Tracheostomy is one of the most commonly performed surgical procedures in the intensive care unit (ICU). After its introduction, percutaneous dilatational tracheostomy (PDT) has been recognized in western countries as a reliable alternative to surgical tracheostomy. However, data on the safety and feasibility of PDT performed by medical intensivists are limited in Korea. METHODS: To evaluate the safety and feasibility of PDT performed by medical intensivists and to compare with those of surgical tracheostomy (ST), we retrospectively analyzed the clinical characteristics of all prospectively registered patients who underwent either PDT or ST in medical ICU from December 2010 to July 2011. RESULTS: A total of 81 patients underwent tracheostomy over the study period: PDT in 56 (69%) and ST in 25 (31%). One patient in whom major bleeding developed during PDT underwent ST as a substitute for PDT. There were no differences in the demographics, laboratory findings, and parameters of mechanical ventilation between the two groups. Procedure time was significantly shorter in the PDT group (20 [IQR 18-30] min) than that in the ST group (38 [27.5-57.5] min) (p < 0.001). The major complication observed in 24 hours after PDT was bleeding in 6 (11%) patients of the PDT group and 4 (16%) patients of the ST group (p = 0.489). However, surgical interventions for major bleeding were required in 2 patients who underwent. CONCLUSIONS: PDT performed by medical intensivists was safe and feasible. However, immediate surgical assistance should be available when required.
Key Words: airway management; medical; physicians; safety; tracheostomy
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