신경계 중환자실에서 시행한 경피적 확장 기관절개술의 안정성과 타당성

Background: Percutaneous dilatational tracheostomy (PDT) is one of the most commonly performed procedures on critically ill patients, and many studies have shown the safety and feasibility of PDT, but there is limited data of PDT in neurocritical care units. We described our experience on PDT performed by neurointensivist. Methods: The PDTs were performed by a neurointensivist at the bedside using the Griggs guide wire dilating forceps technique. To confirm a secure puncture site, the PDT was done under fiberoptic bronchoscopic guidance. From September 2015 to August 2017, procedural data were prospectively collected, and the patients’ demographic and clinical characteristics were retrospectively reviewed. We analyzed immediate complications of PDT as the primary outcome. Results: The PDTs were performed for 46 patients; and the mean age was 65.9 years, 26 (56.5%) were male, and the mean acute physiology and chronic health evaluation II score was 20.5. Overall, the procedural success rate was 100%, and the mean procedural time was 19.7±9.3 minutes. Periprocedural complications occurred in 13 (28.3%) patients; with 10 having minor bleeding and three having a tracheal ring fracture. There were no serious periprocedural complications of PDT. Conclusion: From our experience, the PDT in the neurocritical care unit was safe and feasible and was implemented without serious complications. KCI Citation Count: 0