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  • 1
    Electronic Resource
    Electronic Resource
    Die translaryngeale Tracheostomie Technik und erste Ergebnisse (1997)
    Springer
    Der Chirurg 68 (1997), S. 531-535 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Translaryngeal tracheostomy ; Operative technique ; Results ; Minimally invasive surgery. ; Schlüsselwörter: Translaryngeale Tracheostomie ; operative Technik ; Ergebnisse ; minimal-invasive Chirurgie.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Die translaryngeale Tracheostomie ist eine neuartige, minimal-invasive Methode zur bettseitigen Tracheostomie von Intensivpatienten. Nach perkutaner Punktion der Trachea unterhalb der ersten Trachealspange und Vorschieben eines Führungsdrahtes oralwärts wird daran eine konische Trachealkanüle fixiert, welche orthograd durchgezogen, aufgerichtet, rotiert und nach caudal vorgeschoben wird. Bei den ersten 25 translaryngealen Tracheostomien an 24 Patienten traten lediglich 2 Komplikationen auf: je einmal eine Fehllage der Kanüle und eine Stomainfektion. Bei einer mittleren Apnoedauer von knapp 80 s war ein Anstieg des PaCO2 um 8,0 ± 6,8 mm Hg festzustellen. Hypoxien wurden nicht beobachtet. Die translaryngeale Tracheostomie stellt eine Alternative zu etablierten Tracheostomiemethoden dar.
    Notes: Summary. Translaryngeal tracheostomy is a new type of minimally invasive technique for bedside tracheostomy in intensive care patients. After percutaneous puncture of the trachea below the first tracheal ring, a conic tracheal cannula is fixed to an orally forwarded guide wire. The cannula is then pulled through in orthograde fashion set up, rotated and pushed forward caudally. Among the first 25 translaryngeal tracheostomies in 24 patients, only two complications appeared: one misplacement of the cannula and one infection of the stoma. During a median apnoea time of about 80 s an average PaCO2 increase of 8.0 ± 6.8 mm Hg was documented; hypoxias could not be seen. Translaryngeal tracheostomy seems to be an appropriate alternative to established tracheostomy methods.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050225
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Punktionstracheostomie versus translaryngeale Tracheostomie Eine prospektiv-randomisierte Studie bei 50 Intensivpatienten (1998)
    Springer
    Der Chirurg 69 (1998), S. 418-422 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Percutaneous dilatational tracheostomy ; Translaryngeal tracheostomy ; Complications ; Results ; Minimally invasive surgery. ; Schlüsselwörter: Punktionstracheostomie ; translaryngeale Tracheostomie ; Komplikationen ; Ergebnisse ; minimal-invasive Chirurgie.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Die Punktionstracheostomie (PT) und die translaryngeale Tracheostomie (TLT) sind relativ neuartige, minimal-invasive Methoden zur Behandlung von langzeitbeatmeten Intensivpatienten. Beide Verfahren werden erstmals innerhalb einer prospektiv-randomisierten Studie an 50 Intensivpatienten (34 m., 16 w., Alter: 18–84 Jahre) hinsichtlich ihrer Frühkomplikationsrate und der perioperativen methodenbedingten Beeinträchtigung der Beatmung verglichen. Bei je 25 Patienten wurde eine PT bzw. eine TLT durchgeführt. Perioperativ wurde in beiden Gruppen keine Hypoxie beobachtet, allerdings war ein Abfall des PaO2 um mehr als 50 mm Hg während der TLT 9mal, bei der PT nur 3mal festzustellen (p = 0,051). Außerdem war der mittlere Anstieg des PaCO2 in der TLT-Gruppe signifikant höher (5,2 ± 6,7 vs. 11,6 ± 8,4 mm Hg; p 〈 0,01). In der PT-Gruppe kam perioperativ keine Komplikation vor, nach TLT mußte einmal zur PT konvertiert werden, nachdem die Kanülenspitze disloziert war. Postoperativ trat einmal eine vorzeitige akzidentelle Dekanülierung nach PT und eine Blutung nach TLT auf. PT und TLT sind bei entsprechender klinischer Erfahrung sichere Methoden. Da bei der TLT unter Umständen mit einer erheblichen Hyperkapnie und einem Abfall des arteriellen Sauerstoffpartialdruckes zu rechnen ist, sollte dieses Verfahren nur bei Patienten ohne spezielle Risiken angewandt werden.
    Notes: Summary. Percutaneous dilatational tracheostomy (PT) and translaryngeal tracheostomy (TLT) are relatively new minimally invasive methods for critically ill patients. To compare the perioperative procedural safety we analyzed the severity of perioperative blood gas changes in a prospective randomized clinical study in 50 patients (34 men, 16 women; age 18–84 years). Additionally, early complications were documented. Twenty-five PTs and 25 TLTs were performed under tracheoscopic guidance. Perioperative hypoxia did not occur in either group; however, a decrease of PaO2 of more than 50 mm Hg was noticed in nine patients during TLT versus three patients with PT (P = 0.051). The mean increase of PaCO2 was significantly higher in the TLT-group (5.2 ± 6.7 vs 11.6 ± 8.4 mm Hg; P 〈 0.01). In the PT group no perioperative complications arose; in the TLT group one procedure was not successful and had to be converted to a PT. Postoperatively, one premature decannulation (PT group) and one bleeding (TLT group) were noticed. PT and TLT are safe methods. Early complications are rare in experienced hands. TLT tends to cause relevant hypercarbia and should therefore be restricted to patients without special risks.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050432
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Percutaneous dilatational tracheostomy – early results and long-term outcome of 326 critically ill patients (1998)
    Springer
    Intensive care medicine 24 (1998), S. 685-690 
    Details
    ISSN: 1432-1238
    Keywords: Key words Percutaneous dilatational tracheostomy ; Complications ; Results ; Tracheal stenosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To analyze perioperative and postoperative complications and long-term sequelae following percutaneous dilatational tracheostomy (PDT). Design: A prospective clinical study of patients undergoing PDT. Setting: Seven intensive care units at a University hospital Patients: 326 intensive care patients (202 male, 124 female; age: 11–95 years) with indications for tracheostomy. Interventions: Using tracheoscopic guidance, 337 PDTs were performed according to Ciaglias' method. In 106 decannulated patients, tracheal narrowing was assessed by plain tracheal radiography. Results: Two procedure-related deaths were seen (0.6 %). Perioperative and postoperative complications occurred with 9.5 % of the PDTs. One of 106 patients, who were followed-up for at least 6 months, showed a clinically relevant tracheal stenosis. Subclinical tracheal stenosis of at least 10 % of the cross-sectioned area was recognized in 46 of 106 patients (43.4 %). In the univariate analysis, the degree of stenosis was influenced by the age of the patient (p = 0.044), the duration of intubation prior to PDT (p = 0.042) and by the duration of cannulation (p = 0.006). These parameters had no statistical significance in a multiple regression model. Conclusion: When performed by experienced physicians, percutaneous dilatational tracheostomy under fiberoptic guidance is a safe method. The risks of early complications and of clinically relevant tracheal stenoses are low. Subclinical tracheal stenoses are found in about 40 % of patients following PDT.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050645
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    Paper (German National Licenses)
    Fulltext
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