经皮气管切开术的临床应用

目的：总结经皮气管切开术在ICU的应用经验。方法：采用Portex全套器械对ICU68例病人行经皮气管切开术的临床资料进行回顾性分析。结果：68例均手术成功。手术时间3．5～10分钟，2例切口少许渗血，无严重并发症。结论：经皮气管切开术具有安全、简单、快速、创伤小、花费低廉的优点，可基本取代传统的气管切开术。     

经皮穿刺气管置管术在临床急救中的应用研究

目的观察经皮穿刺气管置管术（PDT）在危重患者紧急抢救中的应用疗效。方法对18例危重患者用PORTEX LIMITED器械行气管穿刺术，从外套管内送入导引钢丝，沿钢丝导入专用气管导管到气管内，再拔出气管导管内栓庭导丝。结果PDT操作均在20min完成,较常规气管切开所需时间短，且可单人操作，一般可在3-10min完成。顺利者在4-7min完成。术中损伤小。出血量少．创口愈合时间缩短（1～2d）。结论PDT操作方法简便。组织损伤轻微。出血量少。可以单人施术，管肺于息救庭基层医院应用。     

Pediatric transtracheal and cricothyrotomy airway devices for emergency use: which are appropriate for infants and children?

Cricothyrotomy or insertion of a transtracheal device is a life-saving maneuver that may be performed on an emergent or semi-elective basis as a means of bypassing an obstructed upper airway. A surgeon is trained to perform this life-saving procedure whereas most anesthesiologists are not facile with the scalpel. It is for this reason that many percutaneous devices have been developed for use by surgeons and nonsurgeons alike. Unfortunately, the majority of such devices are designed for use in adults and/or teenagers but are not appropriate for neonates and infants. The unique anatomy of the infant larynx, the small size of the cricothyroid membrane, and the technical difficulty of locating the correct anatomical structures make the use of most of these devices impractical if not outright dangerous in neonates and infants. This paper will review many (but not all) of the available devices, associated literature, pitfalls and dangers. It is emphasized that each clinician should become familiar with the advantages and disadvantages of these devices and obtain training with simulators or animal models. A strategy for management of the 'cannot ventilate, cannot oxygenate, cannot intubate' situation should be developed with age and size appropriate equipment.     

Mucus Transport and Surface Damage After Endotracheal Intubation and Tracheostomy. An Experimental Study in Pigs

The effects on mucus transport of different grades of tracheal injury produced experimentally by an intubation tube were studied in 26 pigs. Two of them were not intubated and served as controls, while the rest were anaesthetized and either intubated or tracheostomized, or both, and ventilated for approximately 4.5 h. They were then killed and the trachea and larynx were immediately removed and placed in a specially designed chamber at 3 7^oG and 85 % relative humidity. Cardio-green dye was deposited caudally in the trachea as a mucus marker. The mucus transport was observed macroscopically and the ultrastructure of the tracheal wall at the region of mucus arrest was studied by light microscopy and scanning and transmission electron microscopy. In non-intubated pigs the mucus was transported to the posterior larynx. The ciliated epithelium was usually intact along the pathway where cardio-green-stained mucus had travelled. In pigs which had been intubated and/or tracheostomized, mucus transport stopped completely at different levels of the trachea. The damage to the ciliated epithelium varied; in some animals there was almost none at all and in others there was a patchy loss of a large proportion of the cilia, or complete lack of cilia. Lesions which also included epithelial cells were often seen. Tracheal injury due either to a cuffed endotracheal tube or to a tracheostomy tube, with destruction of epithelium and cilia, causes a barrier to mucus transport, leading to arrest and accumulation of mucus further down in the airway. We were unable, however, to demonstrate a direct correlation between grade of damage and tendency to mucus arrest.     

Rupture of the innominate artery following tracheostomy: Report of a case

(Received for publication on Sept. 9, 1996; accepted on May 12, 1997)     

Minitracheotomy in children

The successful management of sputum retention by minitracheotomy in two 12-year-old patients is reported. Some advantages and potential problems are discussed. This is the first time that minitracheotomy has been reported in this age group.     

An audit of characteristics and outcomes in adult intensive care patients following tracheostomy

Background:

Tracheostomies are commonly performed on critically ill patients requiring prolonged mechanical ventilation. The purpose of this study was to review our experience with surgical and percutaneous tracheostomies and identify factors affecting outcome.

Materials and Methods:

Patients who underwent tracheostomy between January 1999 and June 2008 were identified on the basis of Diagnostic Related Group coding and the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification procedural code. The primary endpoint was in-hospital mortality. Contingency tables were generated for clinical variables and a chi-squared test was used to determine significance.

Results:

One hundred and sixty-eight patients underwent tracheostomy between January 1999 and 30 June 2008. In-hospital mortality was 22.6%. The probability of death was found to be independent of timing of tracheostomy, technique used (percutaneous vs. surgical), number of failed extubations and obesity. On univariate analysis, the null hypothesis of independence was rejected for age on admission (P = 0.014), diagnosis of sepsis (P = 0.0008) or cardiac arrest (P = 0.0016), Acute Physiology and Chronic Health Evaluation II score (P = 0.0319) and the Australasian Outcomes Research Tool for Intensive Care calculated risk of death (P = 0.0432).

Conclusion:

Although a number of patient factors are associated with worse outcome, tracheostomy appears to be a relatively safe technique in the Intensive Care Unit population.     

Successful management of a morbidly obese patient for electroconvulsive therapy with elective tracheostomy

Electroconvulsive therapy (ECT) is a treatment for affective catatonia and requires multiple general anesthetics. Morbid obesity is an increasingly prevalent condition that may complicate the standard anesthetic management of a patient undergoing ECT. We report the successful airway management of a morbidly obese ECT patient via elective tracheostomy.