PDF(Pubmed)
Abstract：
UNASSIGNED: Percutaneous dilatational tracheostomy (PDT), a bedside procedure in intensive care, enhances respiratory support for critically ill patients with benefits over traditional tracheostomy, such as improved safety, ease of use, cost-effectiveness, and operational efficiency by eliminating patient transfers to the operating room. It also minimizes complications including bleeding, infection, and inflammation. Despite decades of PDT evolution and device diversification, adaptations primarily cater to larger Western patients rather than smaller-statured Korean populations. This study assesses the efficacy and appropriateness of the Ciaglia Blue Rhino (Cook Critical Care, Bloomington, IN, USA), augmented with ultrasound, flexible bronchoscopy, and microcatheter techniques, for Korean patients with short stature.
UNASSIGNED: We conducted PDT on 183 intubated adults (128 male/55 female) with severe respiratory issues at a single medical center from January 2010 to December 2022. Patients were divided into two groups for retrospective analysis: a modified group (n=133) underwent PDT with ultrasound-guided flexible bronchoscopy and microcatheter puncture, and a conventional group (n=50) received PDT using only the Ciaglia Blue Rhino device. We assessed clinical and demographic characteristics, outcomes, and complications such as pneumothorax and emphysema. The study also evaluated the suitability and effectiveness of the devices for Korean patients with short stature.
UNASSIGNED: Demographic characteristics including sex, body weight, height, body mass index, obesity status, and underlying diseases showed no significant differences between the two groups. However, the modified group was older (69.5±14.2 vs. 63.5±14.1 years; P=0.01). The sequential organ failure assessment (SOFA) and simplified acute physiology score (SAPS) II score was slightly higher in the modified groups, but no statistically significant differences were observed (7.1±2.3 vs. 6.7±2.3, P=0.31 and 46.7±9.0 vs. 44.0±9.1, P=0.08, respectively). The duration of hospital and ICU stays, as well as days post-PDT, were longer in the conventional group, yet these differences were not statistically significant (P=0.20, P=0.44, P=0.06). Total surgical time, including preparation, ultrasound, bronchoscopy, and microcatheter puncture, was significantly longer in the modified group (25.6±7.5 vs. 19.9±6.5 minutes; P<0.001), and the success rate of the first tracheal puncture was also higher (100.0% vs. 92.0%; P=0.006). Intra-operative bleeding was less frequent in the modified group (P=0.02 for tracheostomy site bleeding and P=0.002 for minor bleeding).
UNASSIGNED: PDT, performed at the bedside in intensive care settings, proves to be a swift and dependable method. Utilizing the Ciaglia Blue Rhino device, combined with ultrasound guidance, flexible bronchoscopy, and 4.0-Fr microcatheter puncture, PDT is especially effective for intubated patients who cannot be weaned from ventilation. This technique results in fewer complications than traditional tracheostomy and is particularly beneficial for patients with respiratory issues and smaller-statured Koreans, potentially reducing morbidity and mortality.
UNASSIGNED: We conducted PDT on 183 intubated adults (128 male/55 female) with severe respiratory issues at a single medical center from January 2010 to December 2022. Patients were divided into two groups for retrospective analysis: a modified group (n=133) underwent PDT with ultrasound-guided flexible bronchoscopy and microcatheter puncture, and a conventional group (n=50) received PDT using only the Ciaglia Blue Rhino device. We assessed clinical and demographic characteristics, outcomes, and complications such as pneumothorax and emphysema. The study also evaluated the suitability and effectiveness of the devices for Korean patients with short stature.
UNASSIGNED: Demographic characteristics including sex, body weight, height, body mass index, obesity status, and underlying diseases showed no significant differences between the two groups. However, the modified group was older (69.5±14.2 vs. 63.5±14.1 years; P=0.01). The sequential organ failure assessment (SOFA) and simplified acute physiology score (SAPS) II score was slightly higher in the modified groups, but no statistically significant differences were observed (7.1±2.3 vs. 6.7±2.3, P=0.31 and 46.7±9.0 vs. 44.0±9.1, P=0.08, respectively). The duration of hospital and ICU stays, as well as days post-PDT, were longer in the conventional group, yet these differences were not statistically significant (P=0.20, P=0.44, P=0.06). Total surgical time, including preparation, ultrasound, bronchoscopy, and microcatheter puncture, was significantly longer in the modified group (25.6±7.5 vs. 19.9±6.5 minutes; P<0.001), and the success rate of the first tracheal puncture was also higher (100.0% vs. 92.0%; P=0.006). Intra-operative bleeding was less frequent in the modified group (P=0.02 for tracheostomy site bleeding and P=0.002 for minor bleeding).
UNASSIGNED: PDT, performed at the bedside in intensive care settings, proves to be a swift and dependable method. Utilizing the Ciaglia Blue Rhino device, combined with ultrasound guidance, flexible bronchoscopy, and 4.0-Fr microcatheter puncture, PDT is especially effective for intubated patients who cannot be weaned from ventilation. This technique results in fewer complications than traditional tracheostomy and is particularly beneficial for patients with respiratory issues and smaller-statured Koreans, potentially reducing morbidity and mortality.
摘要：
■经皮扩张气管切开术（PDT），重症监护病房的床边手术，增强了对危重患者的呼吸支持，与传统的气管造口术相比，例如提高安全性，易用性,成本效益，和操作效率通过消除病人转移到手术室。它还能最大限度地减少并发症，包括出血，感染,和炎症。尽管有数十年的PDT发展和设备多样化，适应主要迎合较大的西方患者，而不是较小的韩国人口。本研究评估了CiagliaBlueRhino（Cook重症监护，布卢明顿,IN,美国),用超声波增强，柔性支气管镜检查，和微导管技术，适合身材矮小的韩国患者。
■我们于2010年1月至2022年12月在单个医疗中心对183名插管的患有严重呼吸道问题的成年人（128名男性/55名女性）进行了PDT。将患者分为两组进行回顾性分析：改良组（n=133）接受超声引导下柔性支气管镜和微导管穿刺的PDT，常规组（n=50）仅使用CiagliaBlueRhino设备接受PDT。我们评估了临床和人口统计学特征，结果，以及气胸和肺气肿等并发症。该研究还评估了该设备对身材矮小的韩国患者的适用性和有效性。
■人口统计特征，包括性别，体重,高度,身体质量指数,肥胖状态，和基础疾病在两组之间没有显着差异。然而,改良组年龄较大(69.5±14.2vs.63.5±14.1年；P=0.01）。改良组的序贯器官衰竭评估(SOFA)和简化急性生理评分(SAPS)Ⅱ评分略高,但没有观察到统计学上的显著差异(7.1±2.3vs.6.7±2.3，P=0.31和46.7±9.0vs.分别为44.0±9.1，P=0.08）。住院时间和ICU住院时间,以及PDT后的日子，在常规组中更长，这些差异无统计学意义(P=0.20,P=0.44,P=0.06).总手术时间,包括准备,超声，支气管镜检查,以及微导管穿刺,在改良组中明显更长（25.6±7.5vs.19.9±6.5分钟;P<0.001),首次气管穿刺成功率也较高（100.0%vs.92.0%；P=0.006）。改良组术中出血较少（气管切开部位出血P=0.02，少量出血P=0.002）。
■PDT,在重症监护病房的床边进行，被证明是一种快速可靠的方法。利用Ciaglia蓝色犀牛装置，结合超声引导，柔性支气管镜检查，和4.0-Fr微导管穿刺，PDT对于不能从通气中断奶的插管患者尤其有效。与传统的气管造口术相比，这种技术的并发症更少，对患有呼吸系统疾病和身材较小的韩国人特别有益。有可能降低发病率和死亡率。
■我们于2010年1月至2022年12月在单个医疗中心对183名插管的患有严重呼吸道问题的成年人（128名男性/55名女性）进行了PDT。将患者分为两组进行回顾性分析：改良组（n=133）接受超声引导下柔性支气管镜和微导管穿刺的PDT，常规组（n=50）仅使用CiagliaBlueRhino设备接受PDT。我们评估了临床和人口统计学特征，结果，以及气胸和肺气肿等并发症。该研究还评估了该设备对身材矮小的韩国患者的适用性和有效性。
■人口统计特征，包括性别，体重,高度,身体质量指数,肥胖状态，和基础疾病在两组之间没有显着差异。然而,改良组年龄较大(69.5±14.2vs.63.5±14.1年；P=0.01）。改良组的序贯器官衰竭评估(SOFA)和简化急性生理评分(SAPS)Ⅱ评分略高,但没有观察到统计学上的显著差异(7.1±2.3vs.6.7±2.3，P=0.31和46.7±9.0vs.分别为44.0±9.1，P=0.08）。住院时间和ICU住院时间,以及PDT后的日子，在常规组中更长，这些差异无统计学意义(P=0.20,P=0.44,P=0.06).总手术时间,包括准备,超声，支气管镜检查,以及微导管穿刺,在改良组中明显更长（25.6±7.5vs.19.9±6.5分钟;P<0.001),首次气管穿刺成功率也较高（100.0%vs.92.0%；P=0.006）。改良组术中出血较少（气管切开部位出血P=0.02，少量出血P=0.002）。
■PDT,在重症监护病房的床边进行，被证明是一种快速可靠的方法。利用Ciaglia蓝色犀牛装置，结合超声引导，柔性支气管镜检查，和4.0-Fr微导管穿刺，PDT对于不能从通气中断奶的插管患者尤其有效。与传统的气管造口术相比，这种技术的并发症更少，对患有呼吸系统疾病和身材较小的韩国人特别有益。有可能降低发病率和死亡率。
