J B Araujo1, J M Añón2, A M García-Fernández3, M N Parias3, A Corrales1, M O Castro1, E González-Higueras1, J C Pérez-Llorens1, M A Garijo1, A García de Lorenzo4. 1. Servicio de Medicina Intensiva, Hospital Virgen de la Luz, Cuenca, España. 2. Servicio de Medicina Intensiva, Hospital Virgen de la Luz, Cuenca, España. Electronic address: jmaelizalde@gmail.com. 3. Servicio de Medicina Intensiva, Hospital Santa Bárbara, Puertollano, Ciudad Real, España. 4. Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, España.
Abstract
OBJECTIVE: To describe the perioperative and postoperative complications in critically ill patients requiring percutaneous tracheostomy using the Ciaglia Blue Dolphin(®) technique. DESIGN: A prospective, observational, cohort study was carried out. SCOPE: Two medical-surgical Intensive Care Units. PATIENTS: Adult patients subjected to prolonged mechanical ventilation. INTERVENTION: Percutaneous tracheostomy using Ciaglia Blue Dolphin(®) with an endoscopic guide. VARIABLES: Demographic variables, intraoperative and postoperative complications, and Intensive Care Unit and ward mortality were recorded. RESULTS: Seventy patients were included. Age: 68.6 ± 12 years (68.6% males). APACHE II score: 23.5±8.7. Duration of mechanical ventilation prior to percutaneous tracheostomy: 14.3 ± 5.5 days. Perioperative complications were recorded in 25 patients. In 23 of them the complications were mild: difficulty inserting the tracheostomy cannula (n=10), mild bleeding (n=7), partial atelectasis (n=3), cuff leak (n=2), and technical inability to complete the procedure (switch to Ciaglia Blue Rhino(®)) (n=1). Severe complications were recorded in 2 patients: severe bleeding that forced completion of the procedure via surgical tracheostomy (n=1), and false passage with desaturation (n=1). None of the complications proved life-threatening. Eleven complications occurred in the learning curve. As postoperative complications, mild peri-cannula bleeding was seen in 2 patients. CONCLUSIONS: Percutaneous tracheostomy using the Ciaglia Blue Dolphin(®) technique with an endoscopic guide is a safe procedure. As with other procedures, the learning curve contributes to increase the incidence of complications. Potential benefits versus other percutaneous tracheostomy techniques should be explored by randomized trials.
OBJECTIVE: To describe the perioperative and postoperative complications in critically illpatients requiring percutaneous tracheostomy using the Ciaglia Blue Dolphin(®) technique. DESIGN: A prospective, observational, cohort study was carried out. SCOPE: Two medical-surgical Intensive Care Units. PATIENTS: Adult patients subjected to prolonged mechanical ventilation. INTERVENTION: Percutaneous tracheostomy using Ciaglia Blue Dolphin(®) with an endoscopic guide. VARIABLES: Demographic variables, intraoperative and postoperative complications, and Intensive Care Unit and ward mortality were recorded. RESULTS: Seventy patients were included. Age: 68.6 ± 12 years (68.6% males). APACHE II score: 23.5±8.7. Duration of mechanical ventilation prior to percutaneous tracheostomy: 14.3 ± 5.5 days. Perioperative complications were recorded in 25 patients. In 23 of them the complications were mild: difficulty inserting the tracheostomy cannula (n=10), mild bleeding (n=7), partial atelectasis (n=3), cuff leak (n=2), and technical inability to complete the procedure (switch to Ciaglia Blue Rhino(®)) (n=1). Severe complications were recorded in 2 patients: severe bleeding that forced completion of the procedure via surgical tracheostomy (n=1), and false passage with desaturation (n=1). None of the complications proved life-threatening. Eleven complications occurred in the learning curve. As postoperative complications, mild peri-cannula bleeding was seen in 2 patients. CONCLUSIONS: Percutaneous tracheostomy using the Ciaglia Blue Dolphin(®) technique with an endoscopic guide is a safe procedure. As with other procedures, the learning curve contributes to increase the incidence of complications. Potential benefits versus other percutaneous tracheostomy techniques should be explored by randomized trials.
Authors: José M Añón; María Soledad Arellano; Manuel Pérez-Márquez; Claudia Díaz-Alvariño; José A Márquez-Alonso; Jorge Rodríguez-Peláez; Kapil Nanwani-Nanwani; Ana Martín-Pellicer; Belén Civantos; Alba López-Fernández; Irene Seises; Jorge García-Nerín; Juan C Figueira; Henar Casero; Javier Vejo; Alexander Agrifoglio; Lucía Cachafeiro; Mariana Díaz-Almirón; Jesús Villar Journal: Trials Date: 2021-06-29 Impact factor: 2.279