Yoğun bakım ünitemizdeki (YBÜ) perkütan trakeotomi pratiğimiz

Abstract

P apillary thyroid carcinoma (PTC) is the most common endocrine malignancy. [1] The incidence of papillary thyroid cancer is increasing tremendously in developed countries, mostly because of the determination of intrathyroidal papillary microcarcinomas that has led to suspects regarding overdiagnosis and overtreatment. [2][3][4] The incidence of thyroid carcinoma increased by three-fold between 1975 and 2009 in the US and was reported to be 15 times greater in 2011 than in 1993, which is mainly due to the initiation of a national cancer research program, in South Korea. [5,6] Although the prevalence of clinically diagnosed PTC is 1%, the prevalence of occult papillary carcinoma reaches up to a rate of 35.6% in the general population at autopsies. [7] However, despite the sudden increase in thyroid cancer, cancer mortality did not increase. [5,6] Papillary thyroid microcarcinomas (PTMCs) are tumors with Papillary thyroid carcinoma is the most common endocrine malignancy. Papillary thyroid microcarcinomas (PTMCs) are tumors with a size of ≤1 cm. The biological behavior of these tumors differs due to the presence of their aggressive features. The prognosis of PTMCs with high-risk features, such as clinical node metastasis, distant metastasis, and significant extrathyroidal extension to the tracheal or recurrent laryngeal nerve invasion, is poor, even if a sufficient immediate surgery is performed at diagnosis. However, PTMCs without these aggressive features are low-risk tumors because of their indolent and slow growth behaviors. The increase in thyroid cancer incidence is mostly a result of overdiagnosis of small low-risk PTMCs with indolent clinical course. Despite the sudden increase in thyroid cancer incidence worldwide, cancer mortality did not increase. Although the traditional treatment strategy for PTMC is immediate surgery at diagnosis, because of the rather low disease-specific mortality rate, low recurrence rate, and potential risk for postoperative complications, active surveillance has been proposed recently as an alternative option for PTMCs without invasion, metastasis, or cytological or molecular characteristics. The recent data support that active surveillance of low-risk PTMC should be the initial treatment modality, because only a small percentage of low-risk PTMCs show signs of progression, and delayed surgery has not caused significant recurrence. However, recent management guidelines are shifting toward more conservative treatments, such as active surveillance. Although there is an increase in the number of studies related to active surveillance, prospective studies have been mostly from academic referral centers in Japan. The world still needs class 1 evidence extended prospective studies originating from different geographic regions. Active surveillance may be a good alternative to immediate surgery for appropriately selected patients with PTMC.

Yoğun Bakım Ünitemizde Perkütan Yöntemle Açılan Trakeostomi Deneyimlerimiz; Retrospektif Analiz

“…PT has numerous advantages such as requiring small skin incision, causing less tissue damage, bleeding, and stoma infection, and easy bedside application (7,10,11). For these reasons, PT is more popular than surgical tracheostomy (7,10). However, a study conducted in Turkey evaluated ICU patients for a period of three years and reported that out of the 203 patients that underwent tracheostomy during the study period, 99 (48.8%) of them underwent PT and the remaining 104 (51.2%) patients underwent surgical tracheostomy (1).…”

“…Percutaneous tracheostomy (PT) has been shown to be a viable method due to its key advantages including easy bedside application, low complication rates, and short application time. Moreover, PT is frequently used in ICU patients requiring elective tracheostomy (6,7). As PT is an invasive procedure, it may lead to both intra-and post-operative complications.…”

Retrospective Analysis of Percutaneous Tracheostomi Cases in Intensive Care Unit

“…PT'nin avantajları; küçük bir deri insizyonu ile yapılması, dokuda daha az hasarlanma yapması, kanamada azalma, stoma enfeksiyonunda azalma, trakeal problemlerde azalma, kozmetik deformitede azalma, yatak başı yapılabilmesi, ameliyathane gereksinimi olmadığı için transport riski ve masrafında azalma, kısa sürede açılabilmesi, komplikasyon oranlarında azalma ve cerrahi eğitimi olmayan doktorlar tarafından da açılabilmesidir (5,7,9,10). Bu nedenlerden dolayı PT cerrahi trakeostomiye oranla daha çok tercih edilmektedir (7,9). Bizim YB'de son 2 yılda yatan 276 hastanın 31'ine cerrahi trakeostomi, 132'sine PT açıldı.…”

“…Genel olarak cerrahi trakeostomi uygulamaları daha çok kulak burun boğaz ve göğüs cerrahisi uzmanlarınca uygulanırken, perkütan trakeostomi (PT) uygulamaları daha çok kulak burun boğaz, anesteziyoloji ve reanimasyon ve YB uzmanları tarafından uygulanabilmektedir (3,4). Günümüzde birçok PT yöntemi tarif edilmiş olmasına rağmen en sık kullanılan teknikler PT'nin kolay uygulanabilirliği, düşük komplikasyon oranları ve hasta yatağında kısa sürede uygulanabilen bir yöntem olduğu için son yıllarda daha çok tercih edildiği ve özellikle elektif trakeostomi açılacak olgularda YB ünitesinde sıklıkla kullanıldığı görülmektedir (4,7). PT işlemi sırasında; kanama, hipoksi, hiperkapni, pnömotoraks, pnömomediastinum, deri altı amfizem, paratrakeal yerleşim, trakea duvar yaralanması, aspirasyon, ani ölüm, özofagus hasarı gibi komplikasyonlar görülebilmektedir (4,8).…”

Evaluation of Long-term Intensive Care Patients in a Cardiac Surgery Center

“…Tracheostomy is a surgical method frequently applied to patients with long term mechanical ventilation, for treatment of upper respiratory tract obstruction, and those with endotracheal intubation in ICU and predicted to remain linked to a mechanical ventilator for a long period (27,28). Percutaneous tracheostomy (PT) is easily performed, has low complication rates and can be performed in a short period at the patient's bedside so it is mostly chosen in recent years and is frequently used in the ICU for cases with elective tracheostomy especially (29,30). During the PT procedure, complications like hemorrhage, hypoxia, hypercapnia, pneumothorax, pneumomediastinum, subdermal emphysema, paratracheal insertion, tracheal wall injury, aspiration, sudden death, and esophagus injury may be observed (29).…”