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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
ORIGINAL ARTICLES INTENSIVE THERAPY
Minerva Anestesiologica 1998 November;64(11):505-12
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.