Factibilidad de la traqueotomía percutánea para pacientes no intubadosregistro de 1032 procedimientos en una Unidad de Cuidados Intensivos de tercer nivel
- Royo-Villanova Reparaz, Mario
- Pablo Ramírez Romero Director
- José Galcerá Tomás Director
Defence university: Universidad de Murcia
Fecha de defensa: 13 June 2016
- José Miguel Pérez Villares Chair
- Rubén Jara Rubio Secretary
- José Luis Escalante Cobo Committee member
Type: Thesis
Abstract
ABSTRACT OBJETIVE The primary study outcome was an assessment of the feasibility and safety of direct Percutaneous Tracheotomy (PT) in a prospective cohort of critically ill patients who were not intubated at the time of PT performance. Additionally, we explored the results and complications of this new procedure and compare them with those of classical PT in an overall population of intubated critically ill patients. METHODS This was a prospective, non-randomized, single-center trial conducted in the 32-bed intensive care unit (ICU) of a tertiary hospital that serves both surgical and clinical patients. This study analyzed a prospective registry of all consecutive PT procedures performed in the ICU from December 2007 to December 2014. Among the 1032 PT procedures performed during the study period, 929 were performed in previously intubated patients under mechanical ventilation and deep sedation as described previously by Ciaglia in a report of classical PT (CPT). PT was performed directly (DPT) in an additional 103 patients in whom prolonged MV could be anticipated prior to intubation. RESULTS During the 7-year study period, a total of 1040 tracheotomies were performed; of these, 1032 involved a PT procedure (8 were surgical and were not included in the analysis). Of the patients who underwent PT, 929 were intubated (CPT) and 103 were not (DPT). Both groups had similar characteristics in terms of age, percentage of women, body mass index, APACHE II score at admission, and personal history. In contrast, the groups differed with respect to the leading cause of admission; patients who underwent DPT were more likely to have suffered neuropathy or spinal cord injury and less frequently to have experienced trauma or brain damage. The groups did not differ in terms of complications, with the exception of a more frequent occurrence of post-procedural atelectasis in the CPT group. No deaths directly related to the technique occurred in DPT group, in contrast to 0.4% in the CPT group; however, this difference were not significant. Moreover, none of the patients in DPT group presented vomit, or clinically significant aspiration, also, none required rescue intubation during the procedure. Patients who underwent DPT carried the tracheotomy for fewer days and had a shorter ICU stay; however, the groups did not differ with regard to 28-day mortality.