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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 1998 November;64(11):505-12

language: Italian

Ciaglia’s per­cut­ane­ous dil­a­ta­tive trach­e­os­to­my in inten­sive ­care. Perioperative com­pli­ca­tions and ­long-­term ­results

Minuto A., Besozzi A., Bertolini M., Spanu P., Iapichino G.

Ospedale «S. Paolo» - Milano, Servizio Anestesia e Rianimazione, II Unità Operativa


Background and aim. The intro­du­c­tion of per­cut­ane­ous tra­che­os­tom­ic tech­niques ­using dil­a­ta­tion (PDT) has led to the grad­u­al dis­use of con­ven­tion­al meth­ods of sur­gery. The aim of ­this ­study was to eval­u­ate ven­til­a­to­ry func­tion in crit­i­cal ­patients dur­ing the exe­cu­tion of PDT ­using Ciaglia’s meth­od as ­well as, in the post­op­er­a­tive ­phase, the ­long-­term ­results, name­ly endo­tra­cheal ­lesions and cos­met­ic defor­mities of the sto­ma.
Experimental ­design. A pros­pec­tive ­study was car­ried out on a con­sec­u­tive ­series of ­adult ­patients.
Setting. The inten­sive ­care ­ward of a 600-bed teach­ing hos­pi­tal.
Patients. A ­group of 50 crit­i­cal ­patients under­go­ing PDT ­from 1993 to 1996. Valuations of ven­til­a­to­ry func­tion: expir­a­to­ry vol­ume (EV), PaO2 and PaCO2, ­were cal­cu­lat­ed in 40 ­patients under­go­ing PDT. Endoscopic con­trols of the tra­chea ­were per­formed in 21 sur­viv­ing ­patients 60 ­days ­after the remov­al of the tra­che­os­tom­ic ­tube and a cos­met­ic eval­u­a­tion of the ­tube inser­tion ­site was ­also ­made in the ­same ­patients.
Results. During PDT a ­mean reduc­tion of EV was ­observed of 1.4 l/min and PaO2 val­ues ­also dimin­ished 15% accom­pa­nied by a 14.2% ­increase in PaCO2. The endo­scop­ic con­trol per­formed ­after 60 ­days in 21 out of 50 ­patients ­revealed a sub­glot­tal sten­o­sis in 1 ­patient, the pres­ence of non­ste­nos­ing cica­tri­cial gra­nu­lo­ma in 2 ­patients, ede­ma in 2 ­patients and dys­ep­i­thel­isa­tion of the tra­cheal muco­sa in a fur­ther 2 ­patients. The remain­ing 66% ­showed flat­ten­ing of the muco­sa and com­plete res­ti­tu­tium ad inte­grum. No usur­pa­tions and cica­tri­cial trac­tions of the ­tube inser­tion ­site ­were ­observed.
Conclusions. This pros­pec­tive ­study of intra­op­er­a­tive ven­til­a­to­ry func­tion and the ­final out­come of PDT accord­ing to Ciaglia con­firms ­that ­this is a reli­able tech­nique for the ven­til­a­to­ry man­age­ment of crit­i­cal ­patients ­with a low per­cent­age of ­long-­term com­pli­ca­tions.

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