Percutaneous tracheostomy in patients with disorders of the central nervous system.
OBJECTIVE
Patients with disorders of the central nervous system frequently require maintenance of an artificial airway due to impairment of the cough reflex and swallowing, or due to the necessity to apply long-term mechanical ventilation. The technique of percutaneous tracheostomy, introduced in recent years to clinical practice globally, enables tracheostomy and establishment of an artificial airway in a bedside setting, in a quick, simple and minimally traumatic manner. It does not require the operating theatre environment and is associated with lower complication rates than the traditional surgical technique.


METHODS
In the period from March 2003 till February 2007, we performed 75 procedures of Griggs mode percutaneous tracheostomy in intravenous anaesthesia, with use of a disposable Percutaneous Tracheostomy Kit (SIMS Portex, UK). The group of patients comprised 36 women and 39 men. Mean patient age was 57.4+/-17.9 years.


RESULTS
On average, the procedure was performed on the 8th (7.8+/-2.6) day after intubation, and its average duration was 6.0+/-3.3 minutes. The most frequent complication was local bleeding from the site (13%), most of which, however, regressed spontaneously. Also observed were: puncture of the tracheal tube sealing cuff (7%), damage to the isthmus of the thyroid (3%), and extratracheal positioning of the tracheal tube (3%). In all the cases the procedure was concluded successfully.


CONCLUSIONS
Griggs mode is a simple and safe technique enabling percutaneous tracheostomy in patients with pathology of the central nervous system. However, further research is needed to evaluate potential delayed complications of the procedure.
Witkowska
Małgorzata
M
Department of Neuroanaesthesiology, Medical University of Gdańsk. malgosiawit@tlen.pl
Kaczmarek
Ewa
E
Graff
Mariusz
M
Karwacki
Zbigniew
Z
Słoniewski
Paweł
P
Nyka
Walenty
W
D000328:Adult; D000368:Aged; D002493:Central Nervous System Diseases / Q000601:surgery*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D008297:Male; D008875:Middle Aged; D011044:Poland; D019106:Postoperative Hemorrhage / Q000209:etiology; D012121:Respiration, Artificial / Q000009:adverse effects / Q000295:instrumentation*; D012189:Retrospective Studies; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome