Traqueostomía percutánea por anestesiólogos: descripción de técnica con control fibrobroncoscópico directo y resultados en unidad de cuidados intensivos y grandes quemados

Abstract

Introduction: The anesthesiologist often leaves the walls of the operating room to perform procedures in other departments, an activity inherent to his expert airway and critical patient's management. Prolonged mechanical ventilation is one of the factors that increase Intensive Care Unit (ICU) stay, which is associated with increased mortality and an increase in healthcare-associated pneumonia. Percutaneous tracheostomy has reduced the length of stay in the ICU and indirectly, morbidity and mortality. Objectives: To describe the experience and results of percutaneous tracheostomy by Anesthesiologists in the ICU of the Mutual de Seguridad Clinical Hospital between 2013 and 2016. Methods: Case Series Study of percutaneous tracheostomies (TQT), performed by anesthesiologists in the ICU. Results: A 93 patients sample was obtained, 89% male, median age 50.2 years, most frequent diagnoses: polytraumatism 48%, traumatic brain injury 25% and burns 13%. No major complications are described during the procedure, no episodes of hypotension, desaturation or false passage and no cases of loss of the airway, subcutaneous emphysema or pneumothorax. Complications included: a 2,1% rate of minimal bleeding at the tracheostomy fixation site and 1% postsurgical stoma infection. Conclusions: Percutaneous TQT is a widely validated technique in intensive care, with excellent results, a low rate of complications and an evident decrease in health costs without resigning the quality of care. The use of fiberoptic bronchoscopy should be considered a minimum standard given its low cost and the reduction of incidence of serious complications. The performance of this percutaneous procedure by trained anesthesiologists is fast, safe, cost-effective and shows no differences in morbidity or mortality compared with others groups of professionals.