[Transcutaneous dilation tracheostomy in the acute period in patients with penetrating craniofacial injury complicated by intracranial hypertension].
Early tracheotomy is well founded in severe brain injury involving the facial skeleton and skull case. Intracranial hypertension interferes with the safe performance of an operation. The authors developed a procedure for safe paracentetic dilatation tracheostomy (PDT) in the acute phase of severe brain injury. The study covered 15 patients with severe brain craniofacial injury. Surgery was made under intravenous anesthesia (with hypnotics, myorelaxants, narcotic analgesics, and cholinolytic agents). PDT was performed by the combined procedure developed by Sigley and Griegse ("Portex and COOK") under endoscopic guidance (Karl Storz 11001 BN1), by displaying the images. The patient is put to bed, without placing a bolster under the shoulders, the bed head end being elevated at an angle of 30 degrees. Bronchoscopic monitoring was made discretely (20-60 sec) under artificial ventilation through a special connector. There were 3-6 sessions of bronchoscopies. Tracheostomy lasted as long as 24 hours in 5 patients, 48 hours in 12 patients; surgery was made in 7 patients on day 3 after injury. Prior to tracheostomy, a horizontalization test was conducted, which revealed an elevation of intracranial pressure (> or = 20 mm Hg). There were no episodes of intracranial hypertension during tracheostomy. PDT can be safely made in patients with intracranial hypertension when they are put to bed, without placing a bolster under the shoulder, the bed head end being elevated at an angle of 30 degrees under discrete bronchoscopic guidance.
Savin
I A
IA
Goriachev
A S
AS
Gorshkov
K M
KM
Shchepetkov
A N
AN
Fokin
M S
MS
D000328:Adult; D001999:Bronchoscopy; D006259:Craniocerebral Trauma / Q000150:complications*; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D007427:Intracranial Pressure; D008297:Male; D008991:Monitoring, Physiologic; D014139:Tracheostomy / Q000379:methods*; D014950:Wounds, Penetrating / Q000150:complications*