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Clínica médica/Intensiva/Enfermagem

Traqueostomia precoce pode não ter mais contra-indicação absoluta no trauma

04/03/2004
 

 

Nos últimos anos, a traqueostomia percutânea tornou-se procedimento de rotina em muitos hospitais, apesar de ainda ser cercada de diversas contra-indicações, como é o caso do trauma, especialmente os que envolvem lesão do pescoço. Artigo publicado no periódico The Annals of Thoracic Surgery descreve a experiência de cirurgiões israelenses que adaptaram seus protocolos de modo a realizar traqueostomias precocemente em pacientes vítimas de trauma. Segundo os autores, o uso de técnica adequada (procedimento de Griggs modificado) assegura bons resultados com tais pacientes, inclusive levando a traqueostomias mais rápidas e fáceis de serem executadas que os procedimentos cirúrgicos abertos tradicionais.

 The Annals of Thoracic Surgery

Ann Thorac Surg 2004;77:1045-1047
© 2004
The Society of Thoracic Surgeons


Original article: general thoracic

Emergency percutaneous tracheostomy in trauma patients: an early experience

Alon Ben-Nun, MD, PhDa*, Edward Altman, MDa, Lael-Anson E. Best, MDa

a Department of General Thoracic Surgery, Rambam Medical Center, Haifa, Israel

Accepted for publication September 8, 2003.

* Address reprint requests to Dr Ben-Nun, Department of General Thoracic Surgery, Rambam Medical Center, Haifa, Israel 31096
e-mail: mangn@netmedia.net.il

BACKGROUND: In recent years, percutaneous tracheostomy (PCT) has become a routine practice in many hospitals. In the early publications, most authors considered adverse conditions such as short or fat neck or obesity as relative contraindications, whereas cervical injury and emergency were regarded as absolute contraindications. More recently, several reports demonstrated the safety and feasibility of PCT in patients with some of the above contraindications. We, like many others, gradually reduced the contraindications and expanded the indications for PCT. In this paper, we report our early experience with emergency PCT in trauma patients.

METHODS: Ten adult patients suffering from multiple injuries after motor vehicle accident (7) or severe head and neck burns (3) required emergency surgical airway control after failure to accomplish orotracheal intubation. A modified Griggs' technique was used by experienced thoracic surgeons. Recorded data included patient demographics, clinical and anatomic conditions, length of procedure, and complications. Short-term follow-up was performed in the hospital by thoracic staff surgeons. Long-term follow-up was carried out in the outpatient clinic.

RESULTS: Six male and 4 female patients underwent emergency PCT. The mean time from skin incision to intubation was 5.5 minutes including the oxygen insufflation period. There was no failure, no procedure-related complication, and no conversion to open technique. Five patients survived and underwent uneventful decannulation. In approximately 1 year of follow-up, there were no clinical symptoms or signs of complications related to the tracheostomy.

CONCLUSIONS: Emergency PCT using a modified Griggs' technique is feasible and safe. In experienced hands, it might be even easier and faster than the open surgical tracheostomy.


 


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