Application of percutaneous dilated tracheotomy under direct vision in severe neurosurgical patients

Abstract

Objective To contrastive analyze the safety of percutaneous dilated tracheotomy under direct vision (PDTUDV) compared with standard percutaneous dilated tracheotomy (PDT) in severe neurosurgical patients. Methods A total of 420 severe neurosurgical patients were included from January 2012 to December 2021, with 163 cases received percutaneous dilated tracheotomy under direct vision and 257 cases received standard percutaneous dilated tracheotomy. Operation time, as well as complication rates of severe intraoperative bleeding, low oxygen, cardiac arrest, and subcutaneous emphysema, pneumothorax, mediastinal emphysema, tracheal catheter entering the outer airway space, posterior tracheal wall injury and incision infection were recorded. Results Percutaneous dilated tracheostomy under direct vision operation time was longer than standard percutaneous dilated tracheostomy [(21.74 ± 2.90) min vs. (12.74 ± 1.96) min; t = 38.050, P = 0.000]. The complication rate in the standard percutaneous dilation tracheostomy group was 7.78% (20/257), 5 cases (1.95%) with severe intraoperative bleeding, 4 cases (1.56%) with subcutaneous emphysema, one case (0.39%) with pneumothorax, 2 cases (0.78%) with mediastinal emphysema, 2 cases (0.78%) with tracheal catheter entering the outer airway space, 3 cases (1.17%) with posterior tracheal wall injury, and 3 cases (1.17%) with incision infection; the complication rate of percutaneous dilated tracheostomy under direct vision group was 4.29% (7/163), one case (0.61%) with severe intraoperative hemorrhage, 2 cases (1.23%) with subcutaneous emphysema, 2 cases (1.23%) with mediastinal emphysema, one case (0.61%) with tracheal catheter entering the outer airway space, one case (0.61%) with incision infection, there was no significant difference in the complication rate between 2 groups (χ2 = 2.017, P = 0.156). Conclusions Percutaneous dilated tracheostomy under direct vision can be effectively used in severe neurosurgical patients with standard percutaneous dilation tracheostomy uesd limited. It is easy to operate, minimally invasive, and does not increase the complication rate.

DOI: 10.3969/j.issn.1672⁃6731.2023.06.006