Die perkutane Dilatationstracheotomie – Welche Technik sollte angewendet werden? View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

1998-09

AUTHORS

W. Wahl, M. Mann, R. Küchle, T. Junginger

ABSTRACT

Summary The endoscopic guided puncture tracheostomy has established itself in many intensive care units. Manufacturers offer complete tracheostomy kits, based on the described techniques from Ciaglia (Cook®-Set), as well as from Griggs (Portex®-Set). The goal of this investigation was to show the advantages, disadvantages, costs and risks of the puncture tracheostomy and to make a comparison using conventional procedures.Within the framework of a prospective investigation, puncture tracheostomies were performed on 24 of 26 patients, whereby each of the two techniques were used alternately. The length of the operation was comparable for both methods. We observed bleeding in three of the cases completed according to the Ciaglia method; nevertheless, the insertion of the dilator could be mastered without problem. The dilatation tracheostomy could not be completed on two patients due to calcification of the tracheal wall, so that they required a conventional tracheostomy. One case, initially done according to the Griggs method, was changed over to the Ciaglia technique. The Griggs puncture tracheostomy method was more difficult to carry out on obese patients or those with a prominent pretracheal soft tissue layer. Late complications did not appear among the decannulated patients. Regarding personnel and material costs, the Griggs technique was more economical, costing DM 329,76; whereas the technique described by Ciaglia cost DM 594,96 per puncture tracheostomy. The personnel and material costs for the tracheostomy carried out in the operating room totalled DM 576,25 and for the conventional tracheostomy in the intensive care unit was DM 450,13. An examination of literature shows that the conventional method and the two methods of puncture tracheostomy are comparable with respect to complications; however, the puncture tracheostomy procedure could be completed with less technical and organizational effort.The puncture tracheostomy is safe, economical, and requires significantly less organizational effort and is thereby superior to the conventional tracheostomy. In order to achieve the goal of an organizationally uncomplicated, economical, safest possible, low risk tracheostomy, it is advisable to employ both puncture tracheostomy sets. Whereas the Cook®-Set (Ciaglia) was easier to handle under unfavorable anatomic conditions, the Portex®-Set (Griggs) provided a more economical tracheostomy so that one or the other method could be applied, depending on the anatomy. More... »

PAGES

401-407

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s003900050166

DOI

http://dx.doi.org/10.1007/s003900050166

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1041634900


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