RESUMO
INTRODUCTION: When compared with conventional surgery, bronchoscopy-guided percutaneous tracheostomy has demonstrated some advantages. We compare the results obtained with bronchoscopy-guided percutaneous tracheostomy performed by Intensive Care Unit personnel with those of conventional surgery. METHODS: Prospective and descriptive cohort of patients admitted to a respiratory intensive care unit from March 2010 to March 2012. RESULTS: A total of 510 patients were admitted to the respiratory Intensive Care Unit. Tracheostomy was performed in 51 (10%); of which, 27 (53%) underwent bronchoscopy-guided percutaneous tracheostomy, and 24(47%) underwent tracheostomy by conventional surgery. There were no differences between bronchoscopy-guided percutaneous tracheostomy and conventional surgery groups in age (52 ± 16 vs 53 ± 18 years, p = 0.83). Simplified Acute Physiology Score-3 differed among groups (59.4 ± 11.2 vs 51.5 ± 14.3, p = 0.03). Indications for performing tracheostomy were prolonged intubation (74.1% vs 62.5%, p = 0.55), neurologic impairment (22.2% vs 16.6%, p = 0.88), and laryngeal disease (3.7% vs 20.8%, p 0.14). Mean time between intubation and tracheostomy was 13.3 days (range 4-45) vs 13.4 days (range 2-40). There were three minor complications in bronchoscopy-guided percutaneous tracheostomy patients, transient bigeminism in one, and moderate bleeding in two, and one minor complication of moderate bleeding in one patient in the conventional surgery group, p = 0.68. CONCLUSION: Bronchoscopy-guided percutaneous tracheostomy is a versatile and safe alternative for conventional tracheostomy when performed in Intensive Care Unit by personnel with expertise and appropriate training.
Assuntos
Broncoscopia/métodos , Cuidados Críticos/métodos , Unidades de Cuidados Respiratórios , Traqueostomia/métodos , Cirurgia Vídeoassistida , Adulto , Idoso , Broncoscopia/estatística & dados numéricos , Grupos Diagnósticos Relacionados , Feminino , Hospitais Gerais , Humanos , Intubação Intratraqueal , Doenças da Laringe , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso , Recursos Humanos em Hospital , Hemorragia Pós-Operatória/etiologia , Estudos Prospectivos , Traqueostomia/efeitos adversos , Traqueostomia/estatística & dados numéricosRESUMO
Mujer de 64 años, del medio rural, referida por imagen radiográfica anormal del tórax. Veintinueve años antes se había caído de un caballo, produciéndose una severa contusión torácica. Estudios con contraste del aparato digestivo mostraron visceras abdominales dentro del hemitórax izquierdo. La enferma rehusó corrección quirúrgica del defecto por estar, asintomática y sólo sentir "burbujas en el pulmón".
A 64 year old woman was referred by her rural doctor due toan abnormal chest X ray. Twenty nine years before she had fallen from a horse suffering a severe thoracic contusion. Contrast studies of the upper and lower gastrointestinal tract showed abdominal viscerae inside the left thoracic cavity. The patient refused surgical correction because she considered herself to be asymptomatic and her only complaint was "feeling bubbles in the lung".